Urological Clinic Munich-Planegg

Prostate Artery Embolisation (PAE)

A Critical Report on an Alternative Treatment for Benign Prostatic Syndrome (BPS)

In addition to the standard options for surgical "prostate reduction" described on the previous pages, there are now various alternative experimental therapy options available.

These include, for example, embolisation of the prostate arteries. The procedure takes place under local anaesthetic. Through an incision in the groin, special catheters are inserted into the artery and used to close the prostate artery using tiny particles.

Not every patient is suited for this procedure. One prerequisite for the procedure is a prostate of appropriate size. The size of an individual's prostate does not automatically correlate with the symptoms. There are, for example, many patients who have considerable discomfort despite only moderate prostate hyperplasia. Technically easily accessible prostate arteries are also indispensable, but this is not always the case due to the sometimes difficult anatomical conditions in the pelvis and changes to the arteries (arteriosclerosis - the "calcification" of the vessels). Above all, the vessels must be accessible on both sides of the body. The pelvic vessels differ significantly from man to man, so the correct outlet of the correct artery is very variable and in 40% of cases even several main supplying vessels can be found.

The main problem are the numerous collateral prostate supply systems: The gland lies well protected in the pelvis, more precisely below the bladder, in front of the rectum, above the pelvic floor with the sphincters and behind the pubic bone. Complete and permanent interruption of the arterial vessels is simply impossible, as the neighbouring and adjacent organs would also be damaged by the reduced blood circulation.

An often praised advantage is the "safety" of the experimental method, as the patients treated have hitherto experienced no serious complications (e.g. severe blood loss or death). However, the more minor complications are often not reported. In addition to increased radiation exposure, these include delayed onset of effect (one to three months after surgery), frequent postoperative urinary retention, lack of long-term outcome and evidence-based long-term results. Likewise, very few studies providing good comparison with the surgical “gold standard” method have so far been published in medical literature.

In summary, PAE is an experimental method for the treatment of benign prostatic syndrome. Previously published data are not meaningful due to their high selectivity. Long-term data are so far either completely lacking or show a clear inferiority of PAE compared to the proven methods. Therefore, we at the Urological Clinic Munich-Planegg rely on the gold standard for surgical treatment.

Sources/Literature

Shim SR et al. Re: Efficacy and Safety of Prostativ Arteriel Embolization: Systematic Review with Meta-Analyse and Meta-Regression J Urol. 2017; 197: 465-79

Wang et al. Int J Urol. 2015 Aug; 22(8): 766-72. doi: 10.1111/iju.12797.

Bilhim et al. Tech Vasc Interv Radiol. 2012 Dec;15(4): 276-85. doi: 10.1053/j.tvir.2012.09.006

Abt et al.: Prostatic Artery Embolization (PAE): eine kritische Bewertung“ Uro News 2017; 21 (6) S. 28ff

Russo GI, Kurbatov D, Sansalone S, et al. 2015. Prostatic arterial embolization vs open prostatectomy: a 1-year matched-pair analysis of functional outcomes and morbidities. Urology 86: 343-348.