Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms

Purpose: To evaluate efficacy of prostate artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH), prostate volume (PV) > 100 cm(3). Materials and Methods: This was a single-center retrospective cohort study. Between March 2009 and September 2014, PAE was performed in patients with a diagnosis of BPH, PV > 100 cm3, and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical treatment for at least 6 months or who had acute urinary retention. Success was defined as improved symptoms (International Prostate Symptom Score <= 15 and decrease of >= 25% from baseline score), improved quality of life (measured as score of <= 3 points or decrease of >= 1 point from baseline), and no need for additional treatment. Results: PAE was performed in 152 patients 48-87 years old (mean +/- SD 67.4 y +/- 7.5) with mean PV of 134.2 cm(3) +/- 41.8 (range, 101-383 cm(3)). PAE was technically successful in 149 patients (98.0%). Symptomatic control was achieved for a median of 18 months +/- 15.5 (range, 3-66 mo). There were 33 clinical failures (23.6%); 23 occur-red in the short-term (<= 6 mo), and 10 occurred in the medium-term (6-24 mo); there were no long-term failures (> 36 mo). Cumulative clinical success rates were 90%, 87.9%, 83.5%, 81.1%, and 77.8% at 1, 3, 6; 12, and 18 months and 72.4% thereafter to 66 months (5.5 y). Conclusions: PAE provides sustained short-, medium-, and long-term control for LUTS in patients with BPH and PV > 100 cm(3).