Aim: To evaluate the efficacy and safety of superselective embolization and chemoembolization of the prostatic artery as an independent method of treating prostate cancer and BPH.
Materials and methods: From 2004 to 2015, 116 patients with BPH (mean age 73.2+/-5.2 years) underwent prostatic artery embolization. Mean prostate volume ranged from 55 to 296 cc3. From 2011 to 2015, 37 patients with prostate cancer (mean age 72.3+/-2.06 years) were treated with X-ray-guided endovascular chemoembolization. All patients had confirmed PCa, of whom 7 had stage T2a and 30 stage T2c disease. PSA ranged from 0.8 to17 ng/ml (mean 13.1+/-3.9). Prostate volume ranged from 61 to 93 cc3 (mean 69.4+/-9.3). The follow-up ranged from 8 to 42 months.
Results: Prostatic artery embolization in BPH patients resulted in a significant reduction in IPSS symptom score and increase in Qmax. The volume of prostate and nodular mass decreased on average by 53% and 47%, respectively, maximum by 82%. Chemoembolization was effective in 31 (83.7%) patients. An objective response was achieved in reducing the PSA level and prostate volume measured by TRUS, and improved urination. The median PSA at 6 months was - 3.4 +/- 0.02 ng/ml. In all patients, chemoembolization resulted in a marked reduction in the prostate volume. The greatest decrease in the prostate volume was observed at 6 months after treatment. Chemoembolization led to a marked improvement in the quality of urination confirmed by uroflowmetry and IPSS symptom scores. At 12 months, 16 patients with prostate cancer underwent the follow-up biopsy. In 12 cases pathology showed fibrosis and epithelial degeneration without signs of atypia and in 2 cases curative pathomorphosis was observed. Chemoembolization was well tolerated and did not cause any significant complications.
Conclusion: Embolization techniques for BPH and chemoembolization for localized PCa showed good effectiveness and safety in patients who had medical contraindications to traditional treatments.
Keywords: benign prostatic hyperplasia; chemoembolization; prostate cancer; prostatic artery; superselective X-ray-guided endovascular embolization.