Background:

Prostatic Artery Embolization (PAE) is a recognized treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH); however, its impact on patients with both BPH and prostate cancer (PCa) is not well known.

Purpose/Objective:

To evaluate the efficacy of PAE in alleviating LUTS in patients with both BPH and PCa and to determine the impact of PAE on oncologic disease course. 

Materials & Methods:

Between April 2012 and February 2023, all patients with biopsy-confirmed PCa who underwent PAE for BPH with moderate to severe LUTS were included in analysis. Urologic outcome parameters, oncologic markers, and effect on Prostate Imaging Reporting and Data System score (PI-RADS) were evaluated at baseline, three months, and 12 months or more post-procedure.

Results:

25 biopsy-confirmed PCa patients were included for analysis. Baseline Gleason score was 6.7 (± 1.1; range: 6-10) and PI-RAD score was 3.0 (± 1.4; range 1-5). Mean patient age was 74.4 years (55-89 years) with a baseline International Prostate Symptom Score (IPSS) of 19.0 (± 6.6; range: 5-29) and urinary bother (QoL) score of 4.4 (± 1.2; range: 2-6). Bilateral PAE was technically successful in 21/25 cases (84%). There were no major adverse events.

There was a significant improvement in IPSS scores with a mean decrease of 11.8 (95% CI: [7.2, 16.3], p<0.01) by 3 months and 12.2 (95% CI: [6.8, 17.6], p<0.01) at longer-term follow up (mean: 285 days, range 90-1238 days). There was a significant improvement in bother scores with a mean decrease of 3.5 (95% CI: [2.3, 4.8], p<0.01) at 3 months and 3.1 (95% CI: [1.9, 4.4], p<0.01) at longer-term follow-up. Mean prostate volume decreased by 57cm3 (95% CI: [30, 83], p<0.01) and PSA levels decreased by 3.4 (95% CI: [1.0, 5.8,] p>0.01). No significant changes were identified in PI-RADs during follow-up. 

Conclusions:

PAE is safe and effective for improving LUTS in patients with PCa. While a reduction in PSA was observed after PAE, no significant changes were found in radiologic findings of malignancy.