Prostatic Artery Embolisation vs Transurethral Resection of the Prostate for BPH

European Urology

TAKE-HOME MESSAGE

  • This study presented 2-year follow-up data of a randomised trial comparing prostate artery embolisation (PAE) with transurethral resection of the prostate (TURP) among men with refractory symptoms secondary to benign prostatic hyperplasia with prostate sizes 25 to 80 cc, International Prostate Symptoms Score (IPSS) >7, quality-of-life score >2, and Qmax <12 mL/s. In all, 103 patients were initially randomised, 51 to PAE and 52 to TURP, with 34 (PAE) and 47 (TURP) having available data for analysis at 2 years. In the PAE group, mean IPSS decreased from 19 to 10 at 3 months and remained at 10 for 2 years. In the TURP group, IPSS decreased from 18 to 7 at 3 months and was 5 at 2 years. Men undergoing TURP reported greater decreases in quality of life, which continued to improve over 2 years in the TURP group; the scores were stable in the PAE group.
  • Given greater loss to follow-up in the PAE group, benefits of TURP relative to PAE were probably underestimated. As such, these study results suggest that, although PAE may be advantageous as far as perioperative morbidity goes, it cannot match the benefit associated with TURP.

–  Joshua A. Cohn, MD

 Urology

This study is the best evidence to date in support of PAE for treating symptomatic BPH. The 3-month results had confirmed good symptomatic early outcomes compared with TURP but inferior relief of obstruction, as you would expect. The maintenance of these results out to 24 months is an important feature of this paper, but the fact that 21% of patients in the PAE group required TURP due to “unsatisfying clinical outcomes” is the most telling finding. Durability predictably, has become the Achilles heel of many of the newer minimally invasive therapies, most notably the UroLift device, and it appears that this is going to be a significant problem for PAE as well.

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