Prostate Artery Embolization Compared to TURP for Treating BPH
Interview with Dr. Francisco Carnevale, University of Sao Paulo, Sao Paulo, Brazil
Prostate artery embolization (PAE) appears to be safe and effective resulting in significant improvements in International Prostate Symptoms Score (IPSS), quality of life (QoL) , maximal flow rate (Qmax) and prostate volume reduction in men with benign prostatic hyperplasia (BPH)," according to Brazilian researchers. They presented their latest trial findings at #GEST2014 comparing PAE to transurethral resection of the prostate (TURP) and found PAE having significant advantages because it is performed as an outpatient procedure and resulted in no early urinary incontinence nor retrograde ejaculation.
"This study is great news. It showed that the two are similar in regards to improving symptoms and QoL. Overall, lower urinary tract symptoms (LUTS) were significantly reduced compared to baseline and that was true for prostate specific antigen (PSA) values and prostate volume reduction," said study investigator Francisco Carnevale, MD, who is with the University of Sao Paolo.
The data includes 18 months of follow-up suggested that TURP is safe and effective and was slightly better than PAE in improving LUTS, decreasing prostate volume and improving quality of life issues. However, patients were discharged 2-3 days after the procedure and 100% of the TURP patients suffered from retrograde ejaculation and 27% suffered from early urinary incontinence. No cases of retrograde ejaculation or early urinary incontinence occurred in the PAE arm.
Dr. Carnevale said 2 patients (13.3%) from the PAE arm were treated by TURP due to symptom recurrence at 6 and 12 months.
"In the embolization group, there were no cases of earlier urinary incontinence. TURP was done under spinal anesthesia and embolization was outpatient and performed with local anesthesia. TURP required 2 to 3 days in the hospital and that is a factor. We have not compared costs, but in theory TURP may involve more costs."
The trial included 15 TURP patients and 15 PAE patients. The groups were similar in age, although the PAE patients were slightly younger as a group. The mean age of the TURP patients was 66.3 years (range: 55-78 years) and the mean age of the PAE patients was 63.1 years (range: (46-71 years). The mean volume size in the TURP arm was 57.6 and 59.3 in the PAE arm. The PSA levels were similar (3.15 for TURP arm and 3.02 for PAE arm).
"The study began 3 years ago and we were using a different technique. Now, we have modified the technique and with the new technique we have gotten better results than what I am presenting," explained Dr. Carnevale. "We don't have long-term follow-up because it is a new procedure so we need to wait for longer term follow-up."
The study showed that both TURP and PAE were superior to medication for BPH. Dr. Carnevale said the latest approaches to PAE are significantly improving outcomes and he said prospective studies may help provide the scientific data needed to make PAE widely accepted. Dr. Carnevale said "The PErFecTED Technique" in which interventional radiologists (IR) do Proximal Embolization First Then Embolize Distal for PAE and is showing considerable promise.
He said a future trial is now planned called the BEST Study (BPH with EmboSphere Treatment). It is a phase III, FDA IDE approved, international study that will include 12 sites. The researchers hope to enroll 186 patients.