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Adenomatous-Dominant Benign Prostatic Hyperplasia (AdBPH) as a Predictor for Clinical Success Following Prostate Artery Embolization: An Age-Matched Case-Control Study: Beyond the Abstract

Prostatic artery embolisation (PAE) for benign prostatic hyperplasia (BPH) is gaining momentum as a robust alternative to trans urethral resection of the prostate (TURP) [1]. The anatomy of the prostatic artery and accompanying venous drainage is highly variable and was until recently poorly understood [2]. Manipulating fine catheters in to the prostatic arteries allows fine particles to be injected in essence cutting of the blood supply to the prostate gland [3].

The prostate gland then begins to reduce in size relieving symptoms and improving quality of life. Long-term data regarding the efficacy of PAE is limited but studies suggest an approximately 72% success rate at 36 months [3]. However, there is currently limited data on which patients do best following PAE and also which patients to target to this specific therapy.

Our paper [4] looked at which patients had the best outcome following PAE by examining quality of life questionnaires and individual MRI scans performed before and after treatment. Patients were part of the STREAM trial being run at Oxford University Hospitals, UK (Chief Investigator Dr Charles R. Tapping). We performed an age match case control study of PAE in patients with adenomatous dominant BPH versus those with non-adenomatous dominant BPH.

The technical success rate for PAE was 96% and the mean age was 68 years. There was a median reduction of 34% (30–55%) in the adenomatous dominant BPH group, compared to a volume loss of 22% (9–44%) in the non-adenomatous dominant group (p = 0.04).

More importantly, there was greater reduction in IPSS in the adenomatous dominant group. IPSS quality of life scores significantly improved in the adenomatous dominant group (p = 0.007). Whilst sexual function is not important to all men with BPH there are currently no reports of a deterioration in sexual function in the medical literature following PAE and no deterioration in sexual function was reported in our trial. This is the first time adenomatous dominant BPH has been suggested as a predictive factor in the success of PAE. Patients with adenomatous dominant BPH should be considered for PAE as a minimally invasive, low complications strategy for successful management of their BPH. 

Read the Abstract

Written By: Dr Charles R. Tapping

References
1. Pisco JM, Bilhim T, Pinheiro LC, Fernandes L, Pereira J, Costa NV, Duarte M, Oliveira AG. Medium- and Long-Term Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients. J Vasc Interv Radiol. 2016;27:1115-22.
2. Bilhim T, Pisco JM, Rio Tinto H, Fernandes L, Pinheiro LC, Furtado A, Casal D, Duarte M, Pereira J, Oliveira AG, O'Neill JE. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol. 2012;23:1403-15.
3. Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013 Sep;23(9):2561-72. doi: 10.1007/s00330-012-2714-9.
4. Little MW, Boardman P, Macdonald AC, Taylor N, Macpherson R, Crew J, Tapping CR. Adenomatous-Dominant Benign Prostatic Hyperplasia (AdBPH) as a Predictor for Clinical Success Following Prostate Artery Embolization: An Age-Matched Case-Control Study. Cardiovasc Intervent Radiol. 2017 May;40(5):682-689