Prostatic Artery Embolization is safe and effective for medically recalcitrant radiation induced prostatitis.

Abstract Introduction Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) represents 90% of all chronic prostatitis cases and may occur after radiotherapy (RT) for localized prostate cancer (PCa). Medical therapy is effective in approximately 50% of cases, with no therapy demonstrating consistent efficacy in refractory cases. Prostatic artery embolization (PAE) is effective in men with lower urinary tract symptoms and benign prostatic hyperplasia. We report clinical improvement after PAE in a case series of men with CP/CPPS after RT. Materials and Methods Nine men (median age, 72 years, range, 61-83 years) with CP/CPPS after RT for PCa underwent PAE. Baseline International Prostate Symptom Score (IPSS) was recorded in 5 patients (median 23, range 4-26), Chronic Prostatitis Symptom Index score (CPSI) in 6 patients (median 22.5, range 6-34) and quality of life (QoL) score in 8 patients (median 5, range 2-6). Median baseline prostate volume was 49 cc3 (range 22-123 cc3). Patients were followed up at 6 and 12 weeks with QoL, IPSS and/or CPSI and MRI. Results Technical success (i.e. bilateral embolization) was achieved in 78% (n=7) of patients with the other two patients having undergone unilateral embolization with no major complications. Clinical success was seen in 89% (n=8) patients and QoL improved in 78% (n=7) during the follow up period. Summary CP/CPPS after RT for PCa is a highly morbid condition, with medical therapy successful in only 50% of cases. PAE may be a successful therapy for medically recalcitrant CP/CPPS and further studies are necessary to understand the best patient selection and scenario for PAE in the setting of CP/CPPS.