Clinical effectiveness of PAE in men with obstructive prostate cancer.

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

OJ

Omeed Jazayeri-Moghaddas, MD

Resident
University of South Florida

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AR

Alexis Rahman, PA-C

Physician Assistant
Moffitt Cancer Center
JP

Julio Pow-Sang, MD

Chairman, GU Program
Moffitt Cancer Center
KY

Kosj Yamoah, MD, PhD

Chairman, Department of Radiation Oncology
Moffitt Cancer Center
Nainesh Parikh, MD, MBA

Assistant Chief Medical Officer Associate Member, Diagnostic Imaging & Interventional Radiology
Moffitt Cancer Center

Disclosure(s):

Omeed Jazayeri-Moghaddas, MD: No financial relationships to disclose

Nainesh Parikh, MD, MBA: Canon Medical Systems: Consultant (Ongoing), Speaking and Teaching (Ongoing)

Purpose: To review technical and clinical outcomes after prostate artery embolization (PAE) in patients with lower urinary tract symptoms (LUTS) secondary to obstructive prostate cancer (PCa) as opposed to benign prostatic hyperplasia (BPH).

Materials and Methods: This was a retrospective single-center IRB-approved study from December 2016 to September 2022 of 14 patients who had PAE performed for management of LUTS secondary to obstructive PCa. Technical success was defined as bilateral prostatic artery embolization. Clinical outcomes were measured by International Prostate Symptom Score (IPSS), quality of life (QoL) and prostate volume reduction at 6 and 12 weeks post PAE. Complications were reported according to SIR grading criteria.

Results: Baseline averages for age, IPSS, QoL and PV were 69 years of age (range 26-76), 23 (range 10-35), 5.3 (range 3-6) and 97 cc (range 56-196). Technical success was 78% (11/14). Average IPSS, QoL and PV reduction at 6 weeks was 5.7 (range -13-26; n=7; p > 0.05), 2.5 (range 0-5; n=7, p < 0.05) and 36% (range 34-64%; n=4; p=< 0.05), respectively. At 12 weeks reduction was 7.3 (range 4-11; n=5; p > 0.05), 2.6 (range 0-6; n=5; p < 0.05) and 40% (range 36-47%; n=5; p < 0.05), respectively. 3 patients were catheter dependent at baseline but only one was successfully weaned off catheter dependence post PAE. No side effects or SIR grade C complications or greater occurred. All patients received hormonal therapy before and after PAE therefore PSA results are not reported.

Conclusion:

Although limited by small follow up numbers, PAE appears to be less effective at improving clinical symptoms in men who have LUTS from obstructive tumor as compared to BPH. Mechanisms of decreased effectiveness may include altered vascularity/capillary flow within the tumor, relative resistance to reduced flow by the tumor, and decreased amount of embolic that can be delivered to tumor cells. Given the significant volume reduction post PAE, PAE can still be utilized effectively in men with obstructive PCa, however expectations around clinical improvement should be lowered.