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Permanent interstitial brachytherapy for prostate cancer implementing neoadjuvant prostatic artery embolization.

Hathal Haddad1, Horst Hermani1, Peter Bischoff2

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Brachytherapy
|February 6, 2022
PubMed
Summary

Prostatic artery embolization (PAE) effectively reduces prostate volume and urinary symptoms before permanent interstitial brachytherapy (PIB). PAE also leads to significantly lower PSA levels 12 months after PIB, suggesting improved long-term prostate cancer control.

Keywords:
Permanent interstitial brachytherapyProstate cancerProstate specific antigenProstatic artery embolizationToxicity

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Area of Science:

  • Urology
  • Interventional Radiology
  • Oncology

Background:

  • Permanent interstitial brachytherapy (PIB) for prostate cancer can be limited by large prostate volumes.
  • Neoadjuvant hormonal therapy is a common method to reduce prostate size before PIB.
  • Prostatic artery embolization (PAE) is an emerging option for prostate volume reduction.

Purpose of the Study:

  • To evaluate prostate volume changes after PAE.
  • To assess initial clinical results in patients undergoing PAE before PIB.
  • To investigate the impact of PAE on urinary symptoms and prostate-specific antigen (PSA) levels.

Main Methods:

  • Retrospective analysis of 102 patients treated with PIB.
  • 13 patients received neoadjuvant PAE for large prostates (>60 cm³) and severe urinary issues.
  • Prostate volume, International Prostate Symptom Score (IPSS), and PSA levels were measured before and after PAE/PIB.

Main Results:

  • PAE patients had larger initial prostate volumes but achieved significant volume reduction by day 30.
  • PAE significantly decreased IPSS, indicating improved urinary symptom control.
  • PSA levels at 12 months post-PIB were significantly lower in patients who had undergone PAE.
  • Four patients without PAE required interventions for urinary retention post-PIB.

Conclusions:

  • PAE is effective in reducing prostate volume and urinary symptoms prior to PIB.
  • PAE can also serve as a treatment for post-PIB urinary retention.
  • Lower long-term PSA levels post-PAE suggest potential for enhanced prostate cancer control.