PAE: Soon to be the treatment of choice for benign prostatic hyperplasia?
Prostatic artery embolisation has become increasingly important as a minimally invasive option for BPH. The first randomised study on its use vs. drug therapy was published.
Drug therapy for BPH
Drug therapy, based on alpha-blockers and 5-alpha-reductase inhibitors, is the first choice for the treatment of BPH. However, it is associated with a number of side effects, including sexual dysfunction, dizziness and low blood pressure. In addition, its efficacy is often time-limited, necessitating prolonged use.1
How does PAE work?
Prostate artery embolisation is a minimally invasive procedure and is based on the selective irreversible occlusion of the prostate arteries, which ensure the blood supply to the prostate. This leads to tissue shrinkage and symptom relief. PAE therefore offers a permanent solution. It also avoids the side effects of drug therapy.
The intervention takes between 30 minutes and 3 hours, depending on anatomical conditions. Post-intervention, a pressure bandage is applied around the groin for 6-8 hours. PAE can therefore also be performed on an outpatient basis.
The first multicentre study on PAE
Although the intervention has been available for over ten years, until now there have only been individual case reports and no multicentre, randomised studies. This has now changed. Sapoval et al. provide the first multicentre randomised study to compare the effect of PAE and conservative therapy.2
Patients from ten different hospitals in France were included in the study and randomised into the PAE or conservative therapy (CT) groups. All patients had symptomatic BPH that had been treated with an alpha-blocker for at least one month. Symptoms were recorded using the International Prostatic Symptom Score (IPSS).
Outpatient follow-up took place 1, 3, 9, 18 and 24 months after randomisation. At each follow-up, the IPSS/QoL and International Index of Erectile Function (IIEF) questionnaires, adverse events and BPH medication were assessed.
After nine months, the change in the IPSS was:
- -10.0 in the PAE group (95 % confidence interval: -11.8 to -8.3)
- -5.7 in the CT group (95 % CI: -7.5 to -3.8)
The decrease was significantly greater in the PAE group than in the CT group. Similar results were observed in the per-protocol analysis.
PAE: the new method of choice for BPH?
This randomised study shows that urinary function, as assessed by the IPSS and quality of life, improved significantly more after 9 months of PAE than after conservative therapy. This reduction in the PAE group was of a magnitude that is clinically significant for the patients.
The study thus confirms the high potential of minimally invasive therapy for the treatment of BPH, which is currently performed exclusively on an inpatient basis. With increasing experience and technical improvements, PAE will be able to be performed safely and effectively in an outpatient setting in the near future.
- Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA. Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. J Urol. 2001 Aug;166(2):563-8. PMID: 11458069.
- Sapoval M, Thiounn N, Descazeaud A, Déan C, Ruffion A, Pagnoux G, Duarte RC, Robert G, Petitpierre F, Karsenty G, Vidal V, Murez T, Vernhet-Kovacsik H, de la Taille A, Kobeiter H, Mathieu R, Heautot JF, Droupy S, Frandon J, Barry Delongchamps N, Korb-Savoldelli V, Durand-Zaleski I, Pereira H, Chatellier G; PARTEM study group. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. Lancet Reg Health Eur. 2023 Jun 26;31:100672. doi: 10.1016/j.lanepe.2023.100672. PMID: 37415648; PMCID: PMC10320610.