A embolização da próstata consiste em ocluir as artérias nutridoras da próstata através de cateterismo. O bloqueio do fluxo arterial leva a morte de grande parte da próstata que irá murchar e desobstruir o canal que passa através dela. Vale ressaltar que a redução de volume prostático é gradual, assim como os sintomas
Clinical StudyEarly Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study
Author links open overlay panelJulien Frandon MD, PhD a
, Elsa Bey MD b
, Aymeric Hamard MD a
, Hélène Mohammad MD a
, Samia Gonzalez MD c
, Joël Greffier PhD a
, Thierry Chevallier MD, PhD d
, Hélène de Forges PhD a
, Jean-Paul Beregi MD, PhD a
, Stéphane Droupy MD, PhD bShow moreAdd to MendeleyShareCite
https://doi.org/10.1016/j.jvir.2020.10.002Get rights and content
Abstract
Purpose
To evaluate the feasibility of prostatic artery embolization in patients with low-risk prostate cancer (PC) under active surveillance (AS).
Methods
This monocentric prospective pilot study, running from June 2018 to June 2019, included 10 patients with low-risk PC under AS, median age 72 years (range, 62–77 years), with a unilateral focal lesion visible on magnetic resonance (MR) imaging, with Prostate Imaging Reporting and Data System v2 score ≥3/5 confirmed by multiparametric MR imaging-targeted biopsy and Gleason score 6. The patients underwent unilateral prostatic artery embolization with 300–500 μm Embospheres in the affected prostatic lobe. The primary endpoint was technical feasibility (prostate and no off-target ischemia in the imaging). The secondary endpoints included safety, negative biopsies/MR imaging response/functional outcomes at 6 months, and oncologic efficacy at 1 year.
Results
Embolization was successfully achieved in all patients; prostate ischemia was confirmed on multiparametric MR imaging, and no off-target ischemia was reported. No major complications were reported. Four patients (40%) presented with both negative targeted and systematic biopsies at 6 months. No lesions were seen on the MR imaging in 30% of patients. The mean International Prostate Symptom Score and International Index of Erectile Function score were 7 and 19 and 5 and 20 at baseline and 6 months, respectively, with no significant difference. Nine patients (90%) were still under AS at 1 year. One patient (10%) had PC progression outside the target lesion and was switched over to curative radiotherapy.
Conclusions
Prostatic artery embolization is feasible and appears safe for prostate cancer patients under AS, with no impact on erectile function or continence status. These results justify the pursuit of further studies.
European Urology Focus
Available online 24 February 2023
In Press, Corrected ProofWhat’s this?
Systematic ReviewProstatic Artery Embolization in Patients with Prostate Cancer: A Systematic Review
Author links open overlay panelOrlando Burkhardt a
, Dominik Abt b
, Daniel Engeler a
, Hans-Peter Schmid a
, Gautier Müllhaupt c
, Valentin Zumstein aShow moreAdd to MendeleyShareCite
https://doi.org/10.1016/j.euf.2023.02.005Get rights and content
Abstract
Context
Prostatic artery embolization (PAE) is increasingly performed worldwide for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). In contrast, the role of PAE in patients with prostate cancer (PCa) is unclear.
Objective
This systematic review summarizes the current available literature on PAE in patients with PCa regarding oncological and functional outcome.
Evidence acquisition
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. A structured search for the relevant literature from 1985 to 2022 was performed in Medline, Embase, and York CRD. Risk of bias and confounding assessments were performed using the ROBINS tool.
Evidence synthesis
Thirteen trials (12 case series and one animal study using a canine model) were included in this systematic review. Four studies had a prospective study design. The risk of bias was rated moderate to serious in all the studies.
Conclusions
PAE in patients with PCa seems to be a safe procedure and effective regarding the improvement of LUTS. Despite PAE having been shown to be feasible in different treatment scenarios of localized or advanced PCa, the oncological benefits are debatable due to an unreliable tumor response and a lack of controlled trials including long-term follow-up.
Patient summary
We investigated the literature to determine the role of prostatic artery embolization (PAE) in patients with prostate cancer regarding oncological and functional outcomes. The results suggest a similar safety profile and efficacy in terms of functional outcomes to those reported earlier for PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. The role of PAE regarding oncological outcomes has to be assessed further.
Journal of Vascular and Interventional Radiology
Volume 29, Issue 5, May 2018, Pages 589-597
Clinical StudyProstatic Artery Embolization in the Treatment of Localized Prostate Cancer: A Bicentric Prospective Proof-of-Concept Study of 12 Patients
Author links open overlay panelLivio Mordasini MD a
, Lukas Hechelhammer MD c
, Pierre-André Diener MD d
, Joachim Diebold MD b
, Agostino Mattei MD a, Daniel Engeler MD e
, Gautier Müllhaupt MD e
, Suk-Kyum Kim MD c
, Hans-Peter Schmid MD e
, Dominik Abt MD eShow moreAdd to MendeleyShareCite
https://doi.org/10.1016/j.jvir.2018.01.766Get rights and content
Abstract
Purpose
To provide initial data on tumoricidal efficacy of embolization on prostate cancer via histopathologic examination of prostatectomy specimens after embolization.
Materials and Methods
In this bicentric prospective trial, 12 men with localized prostate cancer underwent radical prostatectomy 6 weeks after prostatic artery embolization (PAE) from October 2016 to May 2017. PAE was performed with the use of 100-μm Embozene microspheres (Boston Scientific, Natick, Massachusetts). Response of prostate cancer tissue to PAE was assessed according to tumor regression grades. The major outcome measure was complete histopathologic absence of viable cancer cells, including secondary foci, in the prostatectomy specimens.
Results
Complete necrosis of the index lesion was found in 2 patients and partial necrosis in 5. Considering secondary cancerous foci, viable cancer cells were found in all 12 patients. Pathologic specimens were characterized by demarcated zones of necrotic tissue predominantly located in the central gland. Two patients required additional surgery to remove necrotic bladder tissue caused by PAE.
Conclusions
PAE with the use of 100-μm microspheres failed to achieve complete elimination of tumor cells. Extensive tumor regression was induced in some lesions, highlighting the need for further assessment of PAE as a potential treatment option for prostate cancer.
Palliative Prostate Artery Embolization for Prostate Cancer: A Case Series
- Clinical Investigation
- Arterial Interventions
- Published: 06 May 2019
- Volume 42, pages 1405–1412, (2019)
- Cite this article
CardioVascular and Interventional RadiologyAims and scopeSubmit manuscript
- 1022 Accesses
- 18 Citations
- 7 Altmetric
- Explore all metrics
Abstract
Introduction
Prostate artery embolization (PAE) is recognized as a treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia. LUTS and urinary retention are common in men with prostate cancer (PCa). The purpose of this study was to estimate the efficacy and safety of palliative PAE on LUTS or urinary retention in men with advanced PCa.
Materials and methods
This prospective, single-center trial was conducted from March 2017 to November 2018. The trial protocol was registered online (ClinicalTrials.gov Identifier: NCT03104907). Only men with advanced PCa suffering from LUTS or urinary retention were included. The primary outcome was the ability to void without a catheter and International Prostate Symptom Score (IPSS) in non-catheter-dependent patients. The paired t test was used to analyze changes from baseline with 95% confidence intervals (CI). A p value < 0.05 was considered statistically significant.
Results
Seventeen patients were assessed for eligibility, and 15 patients with a mean age of 73.8 years were enrolled. Four men did not complete follow-up: cancer-related death (n = 2), lost to follow-up (n = 1), and unsuccessful embolization due to severe atherosclerosis (n = 1). Bilateral embolization was achieved in ten cases, and urinary retention resolved in one of six patients. LUTS improved in the remaining (n = 5) patients by a mean 12.2-point reduction in IPSS (95% CI − 23.53; − 0.87). According to the CIRSE classification, two grade 1 and two grade 3 complications occurred.
Conclusion
In this study, palliative PAE was safe and efficient for treatment for LUTS associated with PCa.
Level of Evidence
Level 4, Case Series.
Trial registration ClinicalTrials.gov Identifier: NCT03104907.
Journal of Vascular and Interventional Radiology
Volume 32, Issue 2, February 2021, Pages 247-255
Clinical StudyEarly Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study
Author links open overlay panelJulien Frandon MD, PhD a
, Elsa Bey MD b
, Aymeric Hamard MD a
, Hélène Mohammad MD a
, Samia Gonzalez MD c
, Joël Greffier PhD a
, Thierry Chevallier MD, PhD d
, Hélène de Forges PhD a
, Jean-Paul Beregi MD, PhD a
, Stéphane Droupy MD, PhD bShow moreAdd to MendeleyShareCite
https://doi.org/10.1016/j.jvir.2020.10.002Get rights and content
Abstract
Purpose
To evaluate the feasibility of prostatic artery embolization in patients with low-risk prostate cancer (PC) under active surveillance (AS).
Methods
This monocentric prospective pilot study, running from June 2018 to June 2019, included 10 patients with low-risk PC under AS, median age 72 years (range, 62–77 years), with a unilateral focal lesion visible on magnetic resonance (MR) imaging, with Prostate Imaging Reporting and Data System v2 score ≥3/5 confirmed by multiparametric MR imaging-targeted biopsy and Gleason score 6. The patients underwent unilateral prostatic artery embolization with 300–500 μm Embospheres in the affected prostatic lobe. The primary endpoint was technical feasibility (prostate and no off-target ischemia in the imaging). The secondary endpoints included safety, negative biopsies/MR imaging response/functional outcomes at 6 months, and oncologic efficacy at 1 year.
Results
Embolization was successfully achieved in all patients; prostate ischemia was confirmed on multiparametric MR imaging, and no off-target ischemia was reported. No major complications were reported. Four patients (40%) presented with both negative targeted and systematic biopsies at 6 months. No lesions were seen on the MR imaging in 30% of patients. The mean International Prostate Symptom Score and International Index of Erectile Function score were 7 and 19 and 5 and 20 at baseline and 6 months, respectively, with no significant difference. Nine patients (90%) were still under AS at 1 year. One patient (10%) had PC progression outside the target lesion and was switched over to curative radiotherapy.
Conclusions
Prostatic artery embolization is feasible and appears safe for prostate cancer patients under AS, with no impact on erectile function or continence status. These results justify the pursuit of further studies.
European Urology Focus
Available online 24 February 2023
In Press, Corrected ProofWhat’s this?
Systematic ReviewProstatic Artery Embolization in Patients with Prostate Cancer: A Systematic Review
Author links open overlay panelOrlando Burkhardt a
, Dominik Abt b
, Daniel Engeler a
, Hans-Peter Schmid a
, Gautier Müllhaupt c
, Valentin Zumstein aShow moreAdd to MendeleyShareCite
https://doi.org/10.1016/j.euf.2023.02.005Get rights and content
Abstract
Context
Prostatic artery embolization (PAE) is increasingly performed worldwide for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). In contrast, the role of PAE in patients with prostate cancer (PCa) is unclear.
Objective
This systematic review summarizes the current available literature on PAE in patients with PCa regarding oncological and functional outcome.
Evidence acquisition
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. A structured search for the relevant literature from 1985 to 2022 was performed in Medline, Embase, and York CRD. Risk of bias and confounding assessments were performed using the ROBINS tool.
Evidence synthesis
Thirteen trials (12 case series and one animal study using a canine model) were included in this systematic review. Four studies had a prospective study design. The risk of bias was rated moderate to serious in all the studies.
Conclusions
PAE in patients with PCa seems to be a safe procedure and effective regarding the improvement of LUTS. Despite PAE having been shown to be feasible in different treatment scenarios of localized or advanced PCa, the oncological benefits are debatable due to an unreliable tumor response and a lack of controlled trials including long-term follow-up.
Patient summary
We investigated the literature to determine the role of prostatic artery embolization (PAE) in patients with prostate cancer regarding oncological and functional outcomes. The results suggest a similar safety profile and efficacy in terms of functional outcomes to those reported earlier for PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. The role of PAE regarding oncological outcomes has to be assessed further.