Prostatic artery embolization in treatment of benign prostatic hyperplasia: outcome and efficacy in medium-sized compared to large prostates

Abstract

Abstract Background Prostate artery embolization (PAE) is a minimally invasive procedure commonly performed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. International Prostate Symptom Score (IPSS) is a validated patient questionnaire quantifying LUTS, and quality of life (QOL) and postvoiding residual volume (PVR) were used for patient selection for PAE. Prostate volume is an easily estimated objective parameter across multiple imaging modalities specially with ultrasound. We are comparing the result of embolization by comparing it in large (over 80 mL) and medium-sized prostates (from 51 to 80 mL) volume. We looked at a sample of 88 cases performed at a large teaching hospital between January 2022 and August 2024 with 6-month follow-up. Embospheres between 300/500 microns were injected into the prostatic arteries bilaterally (if technically feasible). Ultrasound was used to measure to estimate prostatic volume. N = 42 had an estimated volume (range 51–80 mL) and N = 46 had an estimate volume > 80 mL. IPSS, QOL, PVR and PV were assessed before and at 1-, 3- and 6-months post-procedure which were collected. The aim of this study is to compare efficacy and outcome of PAE in medium-sized prostate in comparison with the large prostates. Results Both medium-sized and large prostate groups showed statistically significant reductions in prostate volume, IPSS, QoL, and PVR over time ( P -value < 0.001). However, while the percentage reduction in prostate volume was comparable between the two groups across all follow-up points (e.g., 56.42% vs. 60.71% at 6 months, p = 0.055, NS), the large prostate group had significantly greater reductions in PVR at 1, 3, and 6 months (e.g., 77.46% vs. 63.22% at 6 months, p < 0.001). Conversely, the medium-sized group demonstrated significantly greater improvements in IPSS at 1 and 3 months (e.g., 65.02% vs. 59.45% at 3 months, p = 0.004), but these differences were not significant by 6 months. QoL improvements were similar between the groups throughout the study. No major complications were recorded. Conclusion Our results suggest that prostate volume should not be used to exclude patients for PAE.