Emerging Indications for Prostate Artery Embolization

Nainesh Parikh, MD, Moffitt Cancer Center, Tampa, Florida, discusses the emerging indications for prostate artery embolization among patients with prostate cancer. Dr Parikh defines the 2 main indications for this treatment as either before or after definitive radiotherapy for patients with prostate cancer.

Transcript:

I'm Nanish Parikh, I'm the Assistant Chief Medical Officer at Moffitt Cancer Center, and also an Associate Professor in the Department of Diagnostic, Imaging and Interventional Radiology.

Today we'll talk about emerging indications for prostate artery embolization (PAE) in the setting of prostate cancer. I think there's 2 main indications, probably 3, but mostly 2 that we've done a lot of work on.

The 2 main indications are either before or after definitive therapy, definitive radiotherapy to be precise. Men who are eligible for definitive radiotherapy, if they've got a large volume gland, typically greater than 50 ccs or more, and/or concomitant LUTS [lower urinary tract symptoms] with an AUA of greater than or equal to 15, I recommend doing a PAE prior to radiotherapy. My data is showing, or our data I should say, is showing really, that it improves urinary health and it minimizes the risk of urinary functional decline after radiotherapy, which is why I call it neoadjuvant PAE. If you do it at a time that is really good for the patient, so at least 6 weeks prior to radiotherapy, patients can really do well, they can improve well over 6 weeks, and then they can actually do well with the radiotherapy without progressing to urinary functional decline, what I call chronic GU toxicity, or radiation prostatitis.

In that same cohort of men, what we've also shown is that if you can volume reduce the prostate to a significant amount, you can actually hypofractionate your treatment, which really means that men can end up having fewer radiation sessions. The traditional radiotherapy is once a day for 39 sessions, so that's about 8 weeks if you do 5 times a week. You could reduce that to 15 or 26 or even to 5, and in some cases you could even get them to brachytherapy depending on the type of disease. As you can tell, I think there's a lot of work to be done here, but that's the first indication.

The second indication is in men who develop chronic GU toxicity, or what I call post-radiation prostatitis, or what my GU colleagues tend to call chronic pelvic pain syndrome from radiation. In those men, 50% are shown to be medically refractory. And in that 50% cohort, PAE has demonstrated approximately 70% to 80% clinical success for men with severe symptoms. More work to be done, though.

We've been building the data in a multidisciplinary approach, alongside all my radiation oncology colleagues. We actually published most of our data in the radiation oncology journals, because it's so impactful and important for those patients. But really, yes, they come via tumor board, but more than anything, these are specialized research and clinical sessions where we talk about these workflows, and we support it with our own internal data. Rather than a patient preference or a physician preference, what we're really building out are those clinical guidelines and decision trees to support this.