From the Guidelines
Prostate embolization is a viable alternative to surgery for prostate hyperplasia, particularly for patients who wish to consider minimally invasive treatment options and accept less optimal outcomes than traditional surgical methods like TURP. According to the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms 1, prostate artery embolization (PAE) can be offered to men with moderate-to-severe LUTS who wish to consider minimally invasive treatment options. The guidelines recommend that PAE be performed only in units where the work-up and follow-up are performed by urologists working collaboratively with trained interventional radiologists for the identification of PAE-suitable patients 1.
Some key points to consider when evaluating prostate embolization versus surgery include:
- The procedure is minimally invasive and can be performed under local anesthesia, typically taking 1-2 hours, with a shorter recovery period compared to surgery 1.
- Prostate embolization may not be as effective as surgical options like TURP for symptom relief, and its long-term durability remains under study 1.
- The procedure is particularly beneficial for older patients with multiple health conditions who may not tolerate surgery well, those with very large prostates, or patients on blood thinners that cannot be stopped.
- Patients should discuss with their doctor whether prostate embolization is appropriate for their specific situation, as the best treatment depends on prostate size, symptom severity, overall health, and personal preferences 1.
It's essential to weigh the potential benefits and drawbacks of prostate embolization against those of surgical options, considering individual patient factors and the latest evidence-based guidelines 1.
From the Research
Advantages of Prostate Embolization
- Prostate embolization is a minimally invasive treatment option for patients with lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) 2
- It has a beneficial safety profile, with fewer adverse events compared to surgical treatments such as transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) 3
- Prostate embolization can be performed under local anesthesia, and patients can continue taking anticoagulant drugs 2
- There is no upper prostate size limit for prostate embolization, making it a viable option for patients with large prostates 4, 2
Comparison to Surgery
- Prostate embolization has been shown to be effective in relieving lower urinary tract symptoms (LUTS) and reducing prostate size, although the relief of bladder outlet obstruction may be less pronounced compared to surgical treatments 3, 4
- Surgical treatments such as TURP and OSP may be associated with more significant improvements in urodynamic measures and BPH symptoms, but they also carry a higher risk of complications, including retrograde ejaculation 5, 3
- Prostate embolization may be considered a preoperative approach for patients with large prostates, as it can reduce prostate volume and make surgical treatment more feasible 4
Efficacy and Safety
- Studies have shown that prostate embolization is safe and effective in improving symptomatic benign prostatic hyperplasia (BPH) symptoms, with significant reductions in prostate volume, postvoid residual urine volume, and International Prostate Symptom Score (IPSS) 6, 4
- The procedure has been shown to improve erectile dysfunction compared to OSP, and it may have a lower risk of adverse events compared to surgical treatments 3
- However, long-term data on the efficacy and safety of prostate embolization are still limited, and further studies are needed to fully understand its benefits and risks 3, 2