Prostate Artery Embolization Does Not Detect Cancer
Prostate artery embolization (PAE) is a therapeutic procedure, not a diagnostic test, and cannot detect prostate cancer. PAE is an interventional radiology technique designed to treat lower urinary tract symptoms from benign prostatic hyperplasia by blocking blood flow to the prostate, not to identify malignancy 1, 2.
Understanding PAE's Role
PAE is a Treatment Modality, Not a Diagnostic Tool
- PAE involves selective catheterization and embolization of prostatic arteries to reduce prostate volume and alleviate urinary symptoms in patients with benign prostatic hyperplasia 1, 3.
- The procedure uses imaging guidance (fluoroscopy and angiography) to navigate catheters to the prostatic arteries, but this imaging visualizes vascular anatomy, not cancer tissue 1.
- PAE has been studied as a treatment option for patients who already have diagnosed prostate cancer with concurrent lower urinary tract symptoms, but it does not serve as a cancer detection method 2, 4.
Established Cancer Detection Methods
The evidence-based approaches for prostate cancer detection include:
- PSA testing combined with digital rectal examination (DRE) remains the primary screening approach, though 75% of screening-detected cancers are nonpalpable 5.
- Transrectal ultrasound (TRUS) with systematic biopsy has been the standard diagnostic test since 1989, though it has limitations with false-negative rates of 15-46% 5.
- Multiparametric MRI has emerged as a powerful tool for prostate cancer detection and can guide targeted biopsies, significantly increasing detection of clinically significant cancers while decreasing detection of insignificant ones 5, 1.
- Clinical factors including age, symptoms, family history, comorbidity, DRE findings, and TRUS findings should guide the decision to perform biopsy 5.
Common Pitfall to Avoid
Do not confuse PAE with diagnostic imaging modalities. While PAE requires angiographic imaging for procedural guidance, this imaging is focused on vascular anatomy for treatment delivery, not tissue characterization for cancer detection 1, 3. The angiographic images obtained during PAE show blood vessel architecture and flow patterns, which cannot differentiate benign from malignant prostatic tissue.
PAE in the Context of Known Prostate Cancer
- PAE has been investigated as an adjunctive treatment in patients with already-diagnosed prostate cancer to manage urinary symptoms, with technical success rates of 95.53% and clinical success rates of 90.31% 3.
- When used before definitive radiation therapy in prostate cancer patients, PAE can reduce prostate volume by an average of 23.1%, potentially decreasing radiation-related toxicity 6.
- The oncological efficacy of PAE as a cancer treatment remains unclear with pooled rates of only 65.89%, and its role regarding oncological outcomes requires further assessment 3, 4.