Prostatic artery embolisation (PAE) has been associated with an improvement of lower urinary tract symptoms associated with benign prostatic hyperplasia (LUTS/BPH), but conclusive evidence of efficacy from randomised controlled clinical trials has been lacking.
To assess the safety and efficacy of PAE compared with a sham procedure in the treatment of LUTS/BPH.
A randomised, single-blind, sham-controlled superiority clinical trial was conducted in 80 males ≥45yr with severe LUTS/BPH refractory to medical treatment from 2014 to 2019 in a private clinic, with efficacy assessments at 6 and 12 mo after randomisation. One patient in the PAE group and three in the sham group did not complete the study.
Patients were randomised 1:1 upon successful catheterisation of a prostatic artery to either PAE or a sham PAE procedure without embolisation. After 6 mo, all 38 patients randomised to the sham group who completed the single-blind period underwent PAE, and both groups completed a 6-mo open period.
An intention-to-treat analysis of all randomised patients was performed. The coprimary outcomes were the change from baseline to 6 mo in the International Prostate Symptom Score (IPSS) and the quality of life (QoL) score at 6 mo, analysed with analysis of covariance and t test, respectively.
Mean age was 63.8±6.0yr, baseline IPSS 26.4±3.87, and QoL score 4.43±0.52. At 6 mo, patients in the PAE arm had a greater improvement in IPSS, with a difference in the change from baseline of 13.2 (95% confidence interval [CI] 10.2-16.2, p<0.0001), and a better QoL score at 6 mo (difference: 2.13; 95% CI 1.57-2.68, p<0.0001) than the patients in the sham arm. The improvements in IPSS and QoL in the sham group 6 mo after they performed PAE were, respectively, 13.6±9.19 (p<0.0001) and 2.05 ± 1.71 (p<0.0001). Adverse events occurred in 14 (35.0%) patients after PAE and in 13 (32.5%) after sham, with one serious adverse event in the sham group during the open period. No treatment failures occurred. Limitations include a single-centre trial, only severe LUTS/BPH, and follow-up limited to 12 mo.
The improvements in subjective and objective variables after PAE are far superior from those due to the placebo effect.
Clearly superior efficacy of prostatic artery embolisation (PAE) compared with a sham procedure was found in this study, which supports the use of PAE in patients with typical symptoms associated with benign prostatic hyperplasia.
European urology. 2019 Dec 09 [Epub ahead of print]
João Martins Pisco, Tiago Bilhim, Nuno V Costa, Daniel Torres, Joana Pisco, Luis Campos Pinheiro, Antonio Gouveia Oliveira
Interventional Radiology Unit, Hôpital Saint-Louis, Lisbon, Portugal., Interventional Radiology Unit, Hôpital Saint-Louis, Lisbon, Portugal; Curry Cabral Hospital, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal; Radiology Department, NOVA Medical School, Lisbon, Portugal., Radiology Department, NOVA Medical School, Lisbon, Portugal; Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal., Department of Pharmacy, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil. Electronic address: .