Effectiveness and safety of prostatic artery embolization for the treatment of lower urinary tract symptoms from benign prostatic hyperplasia in men with concurrent localized prostate cancer.

PURPOSE To assess clinical effectiveness and safety of prostatic artery embolization (PAE) on lower urinary tract symptoms (LUTS) in the setting of localized prostate cancer (PCa). MATERIALS AND METHODS This was a retrospective, single-center, institutional review board-approved study from December 2016 through June 2020 of 21 patients (median age 72, range 63-83) with moderate LUTS and localized PCa. Clinical effectiveness was evaluated at 6 and 12 weeks by IPSS and QoL improvement. 17 patients were scheduled to receive definitive radiotherapy (RT) after PAE; 13 patients completed RT. Short term imaging signs of oncologic progression were evaluated at 6 and 12 weeks defined by at least one of the following on MRI: increased PIRAD score of index lesion(s) to at least 4; new extra-capsular extension, seminal vesicle involvement or pelvic lymphadenopathy. Nonparametric Wilcoxon Signed Rank test was used for analysis. RESULTS IPSS improved by median 12 (n=19, p<0.0001) at 6 and 14 (n=14, p<0.0001) at 12 weeks, respectively, and QoL improved by median 2 (n=19, p<0.0001) at 6 and 3 (n=3, p<0.0001) at 12 weeks. Prostate volume reduction was median 24% (n=19, p<0.0001) at 6 and 36% (n=12, p=0.015) at 12 weeks, respectively. No patients demonstrated imaging disease progression at 6 (n=16) or 12 (n=8) weeks. Median time from PAE to RT was 90 days. No patients experienced increased PSA post-RT or grade 3 or greater GU toxicity. CONCLUSION PAE is clinically effective and safe for treatment of men with LUTS and BPH in the setting of concomitant, localized, non-obstructive PCa.