Interventional radiology procedure offers relief for elderly men with enlarged prostates
Prostate artery embolization (PAE) is a viable treatment alternative for older patients with benign prostatic hyperplasia (BPH) who are not candidates for surgery.
A new paper in the Journal of Vascular and Interventional Radiology details the safety and feasibility of PAE in men over 80 who experience urinary symptoms related to an enlarged prostate. PAE involves embolizing the arteries supplying the prostate, resulting in reduced blood flow to the gland and potentially alleviating symptoms without surgery. The approach may be particularly useful for older patients who require a less invasive treatment option, which is becoming a greater need amid an aging population.
“Benign prostatic hyperplasia is a common chronic condition in aging men,” Kausthubh Hegde, MBBS, with the division of interventional radiology at Massachusetts General Hospital and Harvard Medical School, and colleagues noted. “The global rise in life expectancy has led to a growing cohort of elderly patients who present with severe lower urinary tract symptoms, recurrent urinary retention, catheter dependence, or prostatic bleeding causing hematuria.”
The utilization and popularity of PAE have grown over the last decade; the American Urological Association has updated its guidelines to reflect this and now recommends PAE as an acceptable minimally invasive treatment option for select patients with symptomatic benign prostatic hyperplasia. Despite this, there is limited evidence of its efficacy in elderly patients.
To address this, researchers recently conducted a retrospective analysis of the cases of men 80 and older who underwent PAE for lower urinary tract symptoms. The study included 58 patients with a mean age of 85.2; half of the patients were treated for lower urinary tract symptoms, while 46.6% had catheter-dependent urinary retention and 25.9% had hematuria. Some patients had multiple indications for treatment.
Technical success was achieved in 57 of 58 patients (98.3%). At 12 months, patients experienced significant improvements in urinary symptoms and quality of life. The mean International Prostate Symptom Score decreased from 18.7 before treatment to 9.3 at 12 months, while the mean quality-of-life score declined from 4.5 to 1.8—statistically significant improvements for both metrics.
Among 26 evaluable patients who had been dependent on urinary catheters, 19 achieved catheter independence, and hematuria resolved in all 12 patients who were treated for bleeding. Overall, clinical success was achieved in 42 of 52 patients. Complications occurred in 10 patients, but were classified as minor, prompting the authors to describe the procedure’s safety profile as “reassuring.”
“These findings support PAE as an important minimally invasive treatment option for elderly patients who are non-surgical candidates or who prefer a less invasive approach,” the team concluded.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.