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Controversies in Prostate Artery Embolization: Future Best Practice.

Piyush Goyal1, Riad Salem1, Samdeep K Mouli1

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Summary

Prostate artery embolization (PAE) offers a safe and effective treatment for benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS). Current data support PAE as a viable option alongside medical management or as a precursor to surgery.

Keywords:
International Prostate Symptom Scorebenign prostatic hypertrophyembolizationprostatic artery embolizationtransurethral prostatectomy

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Area of Science:

  • Urology
  • Interventional Radiology

Background:

  • Lower urinary tract symptoms (LUTS) are common in aging men, often due to benign prostatic hyperplasia (BPH).
  • Prostate artery embolization (PAE) is an increasingly utilized minimally invasive treatment for BPH with a favorable side effect profile.
  • Ongoing discussions regarding optimal PAE techniques necessitate evidence-based best practice recommendations.

Purpose of the Study:

  • To propose best practices for prostate artery embolization (PAE) in managing lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH).
  • To provide guidance for experienced practitioners based on current data and evolving techniques.

Main Methods:

  • Review and synthesis of currently available data on PAE for BPH-induced LUTS.
  • Formulation of recommendations for PAE procedural steps, including imaging, session management, and embolic agent selection.
  • Consideration of PAE's role in primary, recurrent, and refractory disease management.

Main Results:

  • PAE is recommended as a safe treatment option, comparable to medical management and as a potential precursor to surgery.
  • PAE can be effectively performed in a single session, ideally in a hybrid angio-CT suite, without the need for preoperative cross-sectional imaging.
  • Initial PAE procedures should utilize 300- to 500-μm particles, with alternative sizes considered for repeat interventions.

Conclusions:

  • PAE demonstrates efficacy across various gland sizes and can be considered a first-line option for recurrent BPH-related LUTS due to its safety and effectiveness.
  • The proposed best practices aim to guide practitioners in optimizing PAE outcomes and challenging existing biases.
  • PAE should be considered a valuable tool in the armamentarium for managing BPH-induced LUTS.