Reasons to consider prostatic artery embolization

Abstract

Purpose: Prostatic artery embolization (PAE) has emerged as a truly minimally invasive treatment option for patients with lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) over the last few years and is now supported by evidence-based international guidelines. Here, we provide an overview on the profile of PAE based on the most relevant and recent literature.

Methods: A comprehensive review of literature on PAE was conducted on PubMed-Medline. The most relevant literature was summarized narratively.

Results: While there is still a lack of long-term data, efficacy and safety data have been published for the short to mid-term. As with any minimally invasive technique, relief of bladder outlet obstruction is less pronounced after PAE compared to more invasive resective techniques. This is likely to be associated with higher re-intervention rates during the longer term. However, due to its beneficial safety profile, PAE represents an interesting option for many patients and could fill a niche between pharmacotherapy and formal surgical intervention. Given its unique treatment approach, i.e. endovascular instead of transurethral, PAE has a clearly different profile compared to other minimally invasive treatments. Performance with local anesthesia with possible continuation of anticoagulant drugs and no upper prostate size limit are the most important advantages of PAE.

Conclusion: PAE represents a valuable supplement in the treatment armamentarium of LUTS/BPH if patients are selected appropriately.

Keywords: Benign prostatic hyperplasia; Lower urinary tract symptoms; Minimally-invasive treatment; Prostate embolization; Prostatic artery embolization.