Introduction& Objectives:
Prostate artery embolization (PAE) has recently emerged as a viable minimally-invasive option to manage medically refractive benign prostatic hyperplasia (BPH) causing lower urinary tract symptoms (LUTS) in non-surgical candidates. However, the attributes of PAE make it potentially suitable as a first-line alternative treatment to medical therapy for non-complicated bladder outflow obstruction. This is the first reported study comparing PAE and Duodart in treatment-naïve patients.
Methods:
Following urological work-up, treatment-naïve men with BPH causing bothersome lower urinary tract symptoms were randomized to receive medical therapy with Duodart or undergo PAE. All patients underwent urodynamic studies at baseline and after 6 months of their respective treatment. Patients unsatisfied with their improvements after 6 months were given the option of crossing over to the other treatment arm. Statistical analyses were performed using paired t-test or Wilcoxon test as appropriate.
Results:
41 patients were recruited and randomised to PAE or Duodart treatment. The baseline characteristics of both groups were similar, and there were no serious adverse events in either treatment arm. At 6-months post-treatment, PAE had statistically significant greater effect in decreasing prostate size (p=0.0006), post-void residual urine volume (0.0038) and overall IPSS symptom severity score (p=0.0004) compared to Duodart. In addition, PAE significantly increased urine flow rate (Qmax) (p=0.0083) and improved patients’ quality of life (p=0.0002) more than Duodart, with average scores changing from “mostly dissatisfied” to “pleased” for PAE patients at six months.
Conclusions:
Prostate artery embolization was more effective than Duodart in reducing prostate size, relieving LUTS and improving quality of life in treatment-naïve patients over 6 months. Although more studies are needed, PAE could be a more effective first-line treatment and avoid long term medical therapy for BPH.