Prostatic Artery Embolization in Patients with Prostate Cancer: A Systematic Review

Orlando Burkhardt; Dominik Abt; Daniel Engeler; Hans-Peter Schmid; Gautier Müllhaupt; Valentin Zumstein

doi:10.1016/j.euf.2023.02.005

Prostatic Artery Embolization in Patients with Prostate Cancer: A Systematic Review

Eur Urol Focus. 2023 Feb 23:S2405-4569(23)00045-7. doi: 10.1016/j.euf.2023.02.005. Online ahead of print.

Authors

Orlando Burkhardt¹, Dominik Abt², Daniel Engeler³, Hans-Peter Schmid³, Gautier Müllhaupt⁴, Valentin Zumstein³

Affiliations

¹ Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland. Electronic address: o.burkhardt@burkhardt-home.ch.
² Department of Urology, Spitalzentrum Biel/Centre Hospitalier Bienne, Biel/Bienne, Switzerland.
³ Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland.
⁴ Department of Urology, Spital Thun, Thun, Switzerland.

PMID: 36841710
DOI: 10.1016/j.euf.2023.02.005

Abstract

Context: Prostatic artery embolization (PAE) is increasingly performed worldwide for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). In contrast, the role of PAE in patients with prostate cancer (PCa) is unclear.

Objective: This systematic review summarizes the current available literature on PAE in patients with PCa regarding oncological and functional outcome.

Evidence acquisition: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. A structured search for the relevant literature from 1985 to 2022 was performed in Medline, Embase, and York CRD. Risk of bias and confounding assessments were performed using the ROBINS tool.

Evidence synthesis: Thirteen trials (12 case series and one animal study using a canine model) were included in this systematic review. Four studies had a prospective study design. The risk of bias was rated moderate to serious in all the studies.

Conclusions: PAE in patients with PCa seems to be a safe procedure and effective regarding the improvement of LUTS. Despite PAE having been shown to be feasible in different treatment scenarios of localized or advanced PCa, the oncological benefits are debatable due to an unreliable tumor response and a lack of controlled trials including long-term follow-up.

Patient summary: We investigated the literature to determine the role of prostatic artery embolization (PAE) in patients with prostate cancer regarding oncological and functional outcomes. The results suggest a similar safety profile and efficacy in terms of functional outcomes to those reported earlier for PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. The role of PAE regarding oncological outcomes has to be assessed further.

Keywords: Chemoembolization; Prostate cancer; Prostatic artery embolization; Radioembolization; Systematic review.

Publication types

Review