Women's & Men's Health

Session: Wednesday Closing Plenary Session: Act Local, Think Global: IR and its role in Immuno-oncology

Prostate Artery Embolization - Single Center Experience of 1000 Patients with Short, Mid, and Long Term Follow Up

Wednesday, March 8, 2023

10:50 AM – 11:00 AM

Location: Phoenix Convention Center, Hall 6 (Plenary)

Presenting Author(s)

Shivank Bhatia, MD

Professor of Interventional Radiology
University of Miami

Disclosure(s): Embolx: Ownership Interest (Ongoing); Merit Medical: Contracted Research (Ongoing), Research Grant Recipient (Ongoing)

Author/Co-author(s)

Andrew Richardson, MD MBA (he/him/his)

Interventional Radiology Resident
Jackson Memorial Hospital
AM

Aneesha Maini, n/a

Medical Student
University of Miami Miller School of Medicine
Kenneth Richardson, MS-3

University of Miami Medical Student
University of Miami
KS

Khushi Shah, n/a

Medical Student
University of Miami Miller School of Medicine
AB

Ansh Bhatia, n/a

Medical Student
KEM Hospital
RR

Rohit Reddy, BSc

Medical Student
University of Miami Miller School of Medicine
AS

Akshat Sanan, MS-4

University of Miami Medical Student
UNIVERSITY OF MIAMI
JK

Jessica G. Kumar, MD

Assistant Professor Clinical Interventional Radiology
Jackson Memorial Hospital
Hamed Jalaeian, MD

Assistant Professor Clinical Interventional Radiology
University of Miami Health System

Disclosure(s):

Shivank Bhatia, MD: Embolx: Ownership Interest (Ongoing); Merit Medical: Contracted Research (Ongoing), Research Grant Recipient (Ongoing)

Andrew Richardson, MD MBA: No financial relationships to disclose

Kenneth Richardson, MS-3: No financial relationships to disclose

Hamed Jalaeian, MD: No financial relationships to disclose

Purpose: PAE is a minimally invasive treatment of lower urinary tract symptoms (LUTS) and urinary retention secondary to BPH. This study evaluates and expands upon the effectiveness and safety profile of PAE in treating BPH with LUTS or urinary retention.

Materials and Methods: 1000 patients underwent PAE for either BPH with LUTS or urinary retention from January 2014 to September 2022. Mean patient age was 70.2 ± 9.5 years, mean prostate volume was 107.2 ± 65.1 g, median pre-procedure IPSS and QoL scores were 23 (IQR, 18-28) and 5 (IQR, 4-6), respectively. Transradial access was performed in 820 procedures. Patient evaluation occurred at 6-12, 24, 60 and 72-month (mo) intervals post PAE. Adverse events were recorded using the Clavien-Dindo (CD) classification. Two-tailed p < 0.05 was considered significant.

Results: Median follow up was 1027 days (range 39-3184). 3-12, 24, 60 and 72-mo follow-up data is reported in the table below. 6-12 months post PAE median IPSS decreased to 6 (IQR 3-10) (n= 615 p < 0.01), median QoL was 1 (IQR 0-2) (n=615 p< 0.01) and mean prostate size was 70.9 ± 44.7 g (n= 175 p < 0.01). 24 months post PAE median IPSS was 7 (IQR 3-14) (n=106 p < 0.01), median QoL was 1 (IQR 0-3) (n=106 p< 0.01), and mean prostate size was 82.9 ± 47.1 g (n= 59 p < 0.01). 5-years post PAE median IPSS was 3 (IQR 2-14) (n=35 p< 0.01), median QoL was 1 (IQR 0-2) (n=35 p< 0.01), and mean prostate size was 69.3 ± 23.3 g (n= 7 p < 0.01). 6-years after PAE median IPSS was 6 (IQR 3-11) (n=10 p< 0.01) and median QoL was 0.5 (IQR 0-1.8) (n=10 p< 0.01). 67 patients (6.7%) have required a second procedure for recurrent LUTS; 10 underwent a second PAE. Self-limited frequency, urgency, and dysuria (CD grade I) postoperative symptoms occurred in 33.5% of patients. 3 patients had non-target embolization with penile ulceration (CD grade II) which resolved with local conservative measures. 3 patients (0.3%) developed urosepsis (CD grade IV) and were treated with IV antibiotics. 3 patients had TIAs which resolved without further intervention.

Conclusion: PAE is an established safe and clinically effective procedure for patients LUTS secondary to BPH with great short-term to midterm results. Long-term outcomes including maintained LUTS relief and significant improvement in QoL continue to be promising.