CIO 2021-9 Efficacy of prostate artery embolization in low and high risk prostate cancer patients

Purpose: Patients diagnosed with prostate cancer (PCa) are usually put into low and high risk groups. Patients in the low risk category often have a choice of undergoing Active Surveillance (AS), in which they have repeated PSA levels every 6 months along with a digital rectal exam. Those in the high risk group undergo a definitive treatment such as surgery, radiation and/or androgen deprivation therapy. We decided to explore the efficacy of Prostate artery embolization (PAE) in patients who traditionally undergo AS and those who got it as a precursor to definitive therapy.

Material and Methods: A literature review was conducted using Pubmed and Google scholar, and 3 case studies were identified and reviewed to determine the efficacy of PAE in PCa patients.

Results: A total of 31 patients were assessed pre and post embolization. 5 of these patients were in the high risk category. Out of the 5, 2 underwent prostate radiation therapy after PAE. These patients had significant reductions in prostate volumes of 28 and 47%. The other 3 patients underwent pelvic radiation post PAE due to nodal involvements. While they also saw reductions in prostate size post PAE, they were not as significant as the other 2 aforementioned patients. More significantly, all patients had a notable drop in International prostate symptom score from an average of 17.4 to an average of 3.6. 26 patients were in the low risk category. 10 of these patients were tested for target and systemic biopsy pre and post PAE. Of the 10 patients, 4 saw complete elimination of target biopsy, 1 of these patients had elimination of systematic biopsy as well. 1 of the patients saw a target biopsy become a systematic one. The other 16 had PSA immediately before and after, 3 months after and 12-18 months after PAE. Of the 16, 13 had PSA of below 2 after the procedure. 1 patient had a PSA of above 2 3 months after, and 2 more patients recorded a PSA of above 2 12-18 months later.

Conclusions: The aforementioned cases have shown that PAE can be used to significantly reduce prostate volume and LUTS in patients, suggesting that the procedure could be helpful for those with more advanced cancer. The treatment may also keep the PSA levels low for a longer period of time and it may even reduce the number of positive biopsies in patients. Hence, the use of PAE may also be effective in delaying the course of PCa.