Prostatic Artery Embolization in Patients with Advanced Prostate Cancer: A Prospective Single Center Pilot Study

Area of Science:

• Interventional Radiology
• Urology
• Oncology

Background:

• Advanced prostate cancer (PCa) presents significant challenges in treatment.
• Prostatic artery embolization (PAE) is an emerging minimally invasive treatment option.
• Pilot studies are crucial for evaluating novel therapeutic approaches in oncology.

Purpose of the Study:

• To evaluate the efficacy and safety of PAE in men with advanced prostate cancer (PCa).
• To assess functional outcomes and tumor response following PAE.
• To determine the feasibility of PAE using specific microsphere sizes in this patient group.

Main Methods:

• A prospective, single-center, single-arm pilot study involving 9 men with advanced PCa.
• PAE performed using 250-400 µm Embozene microspheres.
• Assessment of International Prostate Symptoms Score (IPSS), urinary peak flow (Qmax), post-void residual urine volume (PVR), prostate volume (TPV), and tumor volume (TV) at 12 weeks and up to 12 months post-procedure.
• Tumor response evaluated by PSA levels and multiparametric MRI for tumor necrosis and regression.

Main Results:

• Significant improvement in IPSS (median 6-point reduction) and PVR (median reduction from 70 mL to 10 mL) within 12 weeks.
• Slight increase in median TPV and tumor volumes observed at 12 weeks.
• Significant tumor necrosis (≥50%) occurred in only one patient; eight patients had >50% viable tumor on post-PAE MRI.
• One instance of Clavien-Dindo Grade 1 adverse event related to PAE.

Conclusions:

• PAE using 250-400 µm microspheres is feasible, safe, and effective for improving functional outcomes in select patients with advanced PCa.
• A cytoreductive effect may be achieved in individual cases, warranting further investigation.
• Larger studies are needed to confirm the efficacy of PAE for tumor response in advanced PCa.