Controversies in Prostate Artery Embolization: Future Best Practice

Piyush Goyal, Riad Salem, Samdeep K. Mouli*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.

Original languageEnglish (US)
Pages (from-to)562-570
Number of pages9
JournalSeminars in Interventional Radiology
Volume39
Issue number6
DOIs
StatePublished - Dec 2022

Keywords

  • benign prostatic hypertrophy
  • embolization
  • International Prostate Symptom Score
  • prostatic artery embolization
  • transurethral prostatectomy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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