Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Comparative Analysis Depending of Prostatic Volume

Purpose: Compare the efficacity of prostatic arterial embolization (PAE) for decreasing lower urinary tract symptoms depending on prostate volume on patients with symptomatic benign prostatic hyperplasia (BPH).

Material and Methods: This retrospective study included all patients who underwent PAE for symptomatic BPH between december 2013 and july 2019. They were separated in three groups: ≤50 mL (group 1), 51 to 80 mL (group 2) and >80 mL (group 3). The primary endpoint was decreasing of IPSS during the follow-up. Evolution of quality of life (QOL), International Index Erectile Function (IIEF-15), prostate specific antigen (PSA) levels and prostate volume were also analyzed.

Results: 269 consecutive patients who underwent a PAE for symptomatic BPH were screened: 32 patients (group 1), 91 patients (group 2) and 146 patients (group 3).
The mean follow-up time was 9.6 months.
Initial IPSS was respectively 20.9 +/- 7.5 points, 21.1 +/- 6.5 points and 18.1 +/- 7.2 points in the groups 1, 2 and 3. The IPSS during follow-up decreased significantly relative to initial IPSS, respectively by 8.0 points (p<0.001), 8.9 points (p<0.001) and 10.2 points (p<0.001), but without significant difference among the groups (p=0.18). The decrease of IPSS was no significant based on the initial prostate volume (p=0.38). A proportional correlation was found between the decrease of IPSS and initial IPSS (p<0.001).
QOL decreased significantly in each group, respectively by 2.1 +/- 1.6 points, 1.9 +/- 1.6 points and 2.3 +/- 1.7 points in groups 1, 2 and 3. There was not significant difference among groups (p=0.11).
Prostate volume decreased by 2.7 mL in group 1 (p=0.13), by 10.6 mL in group 2 (p<0.001) and by 21.6 mL in group 3 (p<0.001).
PSA levels decreased by 0.34 ng/mL in group 1 (p=0.37), by 1.65 ng/mL in group 2 (p<0.001) and by 2.96 ng/mL in group 3 (p<0.001).

Conclusions: PAE is efficace for decreasing lower urinary tract symptoms in patients with symptomatic BPH, as much for small prostate volume as for medium or large prostate volume.