Benign Prostatic Hyperplasia - New Treatment - Written Press

 JORNAL DE NOTÍCIAS- September 20, 2017

 

 

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Interventional News March 2017

List of articles from participation in the SIR annual meeting

*     Daily Mail: Ben Spencer – Prostate Therapy Without Surgery <http://www.dailymail.co.uk/health/article-4291774/Thousands-men-benefit-new-prostate-therapy.html>

*     Daily Mail: Sophie Goodchild – Simple operation to stop chaps going to the loos so often: Non-invasive procedure uses beads to cut off blood supply to the prostate <http://www.dailymail.co.uk/health/article-4310908/Simple-operation-stop-chaps-going-loos-often.html>

*     The Sun: Chloe Mayer – PROSTATE BREAKTHROUGH Groundbreaking prostate treatment can save lives without sufferers having invasive surgery <https://www.thesun.co.uk/living/3036796/groundbreaking-prostate-treatment-can-save-lives-with-suffers-having-invasive-surgery>

*     The Times: Chris Smyth – Bead Treatment Can Save Men From Prostate Surgery <http://www.thetimes.co.uk/edition/news/bead-treatment-can-save-men-from-prostate-surgery-pr0gjwkbn>

*     The Times: Grupreet Narwan – Injections Could Replace Painful Prostate Surgery <http://www.thetimes.co.uk/article/injections-could-replace-painful-prostate-surgery-r0skmkjwh>

*     Men’s Health: Christa Sgobba – This New Treatment Can Shrink Your Enlarged Prostate <http://www.menshealth.com/health/nonsurgical-treatment-for-enlarged-prostate>

*     Jornal Ciencia: Merelyn Cerqueira – Nova terapia para corrigir problemas de próstata sem cirurgia pode beneficiar milhões de homens no futuro <http://www.jornalciencia.com/nova-terapia-para-corrigir-problemas-de-prostata-sem-cirurgia-pode-beneficiar-milhoes-de-homens-no-futuro/>

*     Blesk: Staff – Hope for all men with difficult urination: Treatment of prostate cancer without surgery! <http://www.blesk.cz/clanek/radce-zdravi-a-zivotni-styl-zdravi/454924/nadeje-pro-vsechny-muze-s-problematickym-mocenim-leceni-prostaty-bez-operace.html>

*     Australian Morning Mail: Staff – Lets hope we live long enough to benefit from these breakthroughs <http://morningmail.org/medical-breakthroughs-coming-faster-faster/>

*     Medical Research: Marie Benz – Prostate Artery Embolization Is Less Invasive Choice For BPH Treatment <https://medicalresearch.com/author-interviews/prostate-artery-embolization-is-less-invasive-treatment-for-bph/32831/>

*     Interventional News: Staff – 1,000-patient study indicates prostate artery embolization remains effective for years <https://interventionalnews.com/1000-patient-study-indicates-prostate-artery-embolization-remains-effective-for-years/>

*     BPH News: Janet Stewart – Nonsurgical BPH Treatment, PAE, Reported in Study to Be Effective over Long Term <https://bphnews.com/2017/03/22/nonsurgical-bph-treatment-reported-to-be-effective-over-long-term-in-study/>

 

More News March 2017

SIR: Prostate Artery Embolization Effective Long Term

http://www.auntminnie.com/index.aspx?sec=ser&sub=def&pag=dis&ItemID=116828

Long – Term Data Presented for Prostatic artery embolization to treat BPH – Endovascular Today

http://evtoday.com/2017/03/08/long-term-data-presented-for-prostatic-artery-embolization-to-treat-bph

Prostate Artery Embolizations is less invasive choice for BPH treatments

Prostate Artery Embolization Is Less Invasive Choice For BPH Treatment

Nonsurgical treatment for enlarged prostate remains effective for years

http://www.prnewswire.com/news-releases/nonsurgical-treatment-for-enlarged-prostate-remains-effective-for-years-300421392.html

Society of interventional Radiology, March 4-9

http://www.doctorslounge.com/index.php/news/pb/70609

SIR TODAY

March 7-8, 2017

Expresso Newspaper,  14/01/ 2017

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November 2016

 

Prostatic Artery Embolization – A Promising alternative treatment for benign Prostatic Hyperplasia

By João M. Pisco, MD, PhD, April 2012 Endovascular Today

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 Prostatic Embolization May Benefit Men with BPH BY JOHN SCHIESZER

Renal & Urology News

TAMPA, Fla.—Embolization of the prostatic arteries in men with symptomatic benign prostatic hyperplasia (BPH) is a feasible procedure with good short-term outcomes and low morbidity, according to a new study presented at the Society of Interventional Radiology annual meeting.

Patients say they feel better within just two hours after undergoing the procedure, said lead investigator Joao Martins Pisco, MD, Professor of Radiology at the New University of Lisbon.

He and his colleagues evaluated the efficacy, morbidity and outcomes of prostatic artery embolization in 12 patients with symptomatic BPH. The men had a mean age of 74 years (range 70-78 years). The mean International Prostate Symptom Scores (IPSS) was 21. Four patients had bladder catheters.

The researchers performed magnetic resonance imaging, transrectal ultrasound, fluxometry, and PSA serum testing on all subjects prior to embolization and four and 12 weeks after the procedure. The mean prostate volume before embolization was 96.3 cc. All subjects filled out questionnaires before the procedure and again four and 12 weeks after embolization. Nine patients filled out questionnaires at 24 weeks. (Dr. Pisco: Since you mention that nine patients were evaluated at 24 weeks, we should provide 24-week data) The patients stopped all prostatic medication one week before the procedure. The patients received analgesic and anti-inflammatory medications before, during, and after the procedure.

Embolization was performed with polyvinyl alcohol particles 200 µm under local anesthesia. The procedures were performed with a microcatheter that enabled superselective catheterization of prostatic vessels.

Overall, the procedure was successful in 11 patients (90.9%). The one failure was due to the presence of prostatic arteries that were impossible to catheterize as a result of tortuosity and atherosclerotic changes. All patients except one experienced no significant pain during or after the procedure, Dr. Pisco said. The bladder catheter was removed from two patients five days after the procedure and from two patients 10 days after the procedure.

Without any prostatic medication, BPH symptoms improved in the 11 patients who had successful embolization. Subjects had mean decrease in IPSS of 8.2 points four weeks after embolization and 9.3 points 12 weeks after the procedure. The mean prostate volume decreased from 96.3 to 74.3 cc (22.9%) one month after the procedure. Twelve weeks after the procedure, the mean prostate volume decreased by an additional 9.95% from the measurements obtained one month after embolization. The mean peak urinary flow rate increased by 3.8 mL/sec at four weeks and an additional 1.5 mL/sec at 12 weeks. At 24 weeks, there was not significant changes of the different evaluated parameters in 9 patients in comparison to those at 12 weeks.

Among the four patients who were in urinary retention before embolization, all were able to urinate without a bladder catheter 12 weeks after the procedure. These subjects had a mean IPSS of 6.33 and a mean peak urinary flow rate of 9 mL/sec three months after embolization.

Two of the 12 patients experienced urinary infections after embolization, but there were no other complications, Dr. Pisco said.

 

Jornal Frances

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Correio da Manha – April 2, 2016Prof Pisco 1000th PAE-page-001 Prof Pisco 1000th PAE-page-002

 

Jornal medico.pt – October 2015

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MGF – October 2015

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INTERVENTIONAL NEWS – Issue 59 Setembro 2015

How To Avoid Complications with Prostate artery embolization.

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INTERVENTIONAL NEWS

Issue February 2015

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Interventional News article May 2014

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Following the Press Realase at March 24 in San Diego, the folowing articles were published

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Academic One File – Document

Title:Recent Findings in Vascular Radiology Described by J. Martins Pisco and Colleagues
Source:Hematology Week (Feb. 18, 2013): p98.
Document Type:Brief article
Copyright : COPYRIGHT 2013 NewsRX LLC http://www.newsrx.com/newsletters/Hematology-Week.html
Full Text:
By a News Reporter-Staff News Editor at Hematology Week — Current study results on Vascular Radiology have been
published. According to news reporting originating in Lisbon, Portugal, by NewsRx journalists, research stated,
“Prostatic arterial embolization (PAE) is an experimental alternative treatment for benign prostatic hyperplasia, with
promising preliminary results. In comparison with surgery, its main advantages are the minimally invasive nature,
outpatient setting, rapid recovery, and low morbidity.”
The news reporters obtained a quote from the research, “To avoid complications and to achieve technical success it is
important to know the procedural technique in detail. In addition, for good clinical results, it is important to perform a
bilateral and complete prostatic embolization. In this article, the different technical steps, including the initial site of
puncture and the catheters and guidewires to be used, are described. Identification of the prostatic arteries is crucial.
Correlation between computed tomography angiography and digital subtraction angiography helps to solve the difficulty
of such identification.”
According to the news reporters, the research concluded: “The skills for superselective catheterization of the prostatic
arteries, the amounts of contrast injected, the preparation and size of the used particles and the end point of the
procedure are also described.”
For more information on this research see: How to perform prostatic arterial embolization. Techniques In Vascular and
Interventional Radiology, 2012;15(4):286-9. (Elsevier – www.elsevier.com; Techniques In Vascular and Interventional
Radiology – www.elsevier.com/wps/product/cws_home/623199)
Our news correspondents report that additional information may be obtained by contacting J. Martins Pisco,
Interventional Radiology Department, Saint Louis Hospital, Lisbon, Portugal (see also Vascular Radiology).
Keywords for this news article include: Lisbon, Europe, Portugal, Angiology, Embolization, Vascular Radiology.
Our reports deliver fact-based news of research and discoveries from around the world. Copyright 2013, NewsRx
LLC
Source Citation
(MLA 7th Edition)
“Recent Findings in Vascular Radiology Described by J. Martins Pisco and Colleagues.”
Hematology Week 18 Feb.
2013: 98.
Academic OneFile. Web. 30 Mar. 2014.
Document URL
http://go.galegroup.com/ps/i.do?
id=GALE%7CA320013802&v=2.1&u=swinburne1&it=r&p=AONE&sw=w&asid=50dc627f58962ce6e305a6fcccff36d1
Gale Document Number: GALE|A320013802

Março 24 – (HealthDay News)

New Therapy May Shrink Enlarged Prostate With Fewer Side Effects: Study

‘Embolization’ limits prostate’s blood supply, but experts say more research is needed

New Therapy May Shrink Enlarged Prostate With Fewer Side Effects-page-001

New Therapy May Shrink Enlarged Prostate With Fewer Side Effects-page-002

 

March 23/24 -Press Release from  a Press Conference given in San Diego.

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Expresso Saúde – March, 01, 2014

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Principes de SantéLe jornal de la Médicine Naturelle – Février 2013

 

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Multicare Nº 11 . November, 2013

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Interventional News (September 2013)

PISCO

What do we know about outcomes of prostate embolization in 2013?

When we start PAE we should have clear inclusion and exclusion criteria. After undergoing patient selection, those patients will have pelvic CT angiography (CTA) or pelvic magnetic resonance angiography (MRA) before PAE. This is because it is important to evaluate the pelvic vessels for tortuosity and atherosclerotic changes of the iliac and prostatic arteries’ anatomy.

A specific CT angiography protocol is applied and post-processing using maximum intensity projections (MIP) and volume rendering with 3D reconstructions are obtained. The anatomy and atherosclerotic involvement of the iliac and prostatic arteries, the degree of calcium and stenosis of prostatic origin could by this method be known in advance, before the procedure. CTA avoids catheterization of all other pelvic arteries and its use will ultimately reduce complications. Patients with advanced atherosclerosis of the iliac and prostatic arteries are excluded on the basis of Angio-CT.

With the help of Angio-CT, D5A and roadmaping, the prostatic arteries are catheterized with a coaxial micro-catheter. If there is only one prostatic artery, the micro-catheter should be placed before bifurcation in order to ernbolise both prostatic branches. The end point is the embolization of prostatic branches, with no reflux to other arteries and opacification of the gland. If there are two prostatic arteries on one side, one should start by the anterolateral or cranial branch as this irrigates the central part of the prostate. 50 if this branch is well embolized, we should not be worried about the caudal branch. Nevertheless, it is sometimes also embolized by collateral circulation through anastomosis.

 

Outcomes

In spite of the excellent results of UFE and its similarity to prostatic artery embolization (PAE), the first case of PAE was performed only in 2000 by DeMeritt in a patient with acute urinary retention and persistent haematuria. The patient stopped bleeding immediately after embolization, the patient’s voiding difficulties improved, the prostate volume reduced 40% and there was no sexual dysfunction. In March 2009, we performed the first PAE in a 76-year­old man on acute urinary retention and bladder catheter who refused surgery after two previous TURP. Five days later, the bladder catheter was successfully removed.

In 2010, Carnevale et aI. reported the preliminary results in two patients with acute urinary retention due to BPH successfully treated by prostate artery embolization. One patient had bilateral PAE and the other unilateral PAE. Both patients could urinate spontaneously after removal of the bladder catheter 15 and 10 days after the procedure, respectively. At the

6-month follow-up, ultrasound (US) and magnetic resonance (MR) revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5% and 27.8%, for the patient submitted to unilateral PAE. The patient treated with bilateral embolization complained of retropubic pain for 24 hours treated with non-opioid analgesic. In 2011, Carnevale et aI. reported the midterm follow-up after prostate embolization in the same two patients with BPH.

 

Results trom Lisbon

At SIR 2010, we presented the preliminary results in the first 12 patients. The procedure was successful in 11 of the 12 patients (90.9%). The patients did not feel any pain during or after the procedure, except one. Four patients were in urinary retention before embolization. The vesical catheter was removed 5 days after the procedure in two patients and 10 days in the remaining ones. The symptoms improved in all the patients in whom the embolization was successfully performed (mean decrease in the IP55 of 8.2 points at 1 month and 9.3 points at 3 months). The mean prostate volume decreased from 96.3 to 74.3 cc (22.9%) at 1 month and an additional 9.95% at 3 months. The peak urinary flow rate increased 3.8 mL/sec at 1 month and an additional 1.5 mL/sec at 3 months. At the third month patients urinated without bladder catheter with a mean IP55 of 6.33 and a peak urinary flow rate of 9 mL/sec.

At 51R 2011, we presented the short and medium-term outcomes of PAE in BPH. PAE was technically successful in 66 of the 67 patients (98.5%) and the embolization was bilateral in 63 and unilateral in 3. In 62 patients with clinical success, at last follow-up, all the evaluated parameters had significant clinical improvement.

The remaining 4 patients improved; however, the changes were not significant, and 50 are considered clinical failures. There was one case of a major complication, a 1.5 cm2–sized blad­der wall ischaemia that was treated by surgical removal. 5ixty-two patients were discharged 4-8 hours after the procedure, and the remaining ones were discharged the next morning.

 

More recent findings

At SIR 2012, Carnevale et al. presented eleven patients treated between June 2008 and

November 2010. There was a technical failure (bilateral embolization) in 75% and clinical success in (10/11 patients) 91%. Ali patients were in acute urinary retention with bladder catheter. Patients urinated spontaneously between 4-25 days (mean 12.1) after catheter removal.

Clinical overall improvement in LUTS at one year follow-up was observed by IPSS (mean 2.2) and QoL (mean 0.25). Minimum recta I bleeding (a teaspoon amount) was observed in 3/12 (25%) and focal bladder ischaemia in 1/12 (8.3%) procedures.

Recently we reported the short and medium-term results of PAE in 89 patients. There were 3 technical failures (3%). PAE was bilateral in 86 patients (92%) and unilater~1 in 7 patients (8%). At 1-month follow-up, IPSS decreased by 10 points. QoL score decreased by 2 points, peak urinary flow increased by 38%, prostate volume decreased by 20%, post-void residual volume decreased by 30 mL and IIEF score in­creased by 0.5 (all differences were significant, P<O.O1). These changes were sustained through­out the observation period. Seventy-eight of the 86 patients (91%) were discharged from the hospital 6-8 hours after the procedure. The remaining eight patients were discharged the following morning, 18 hours after the procedure.16 of the 86 patients (19%) had urinary tract infections after embolization that were treated with antibiotics, and there was transient haematuria in nine of the 86 patients (10%) and transient haemospermia that disappeared spontaneously without any treatment in six (7%). Balanoprostatitis occurred in two of the 86 patients (2%) and inguinal haematoma in six (7%). Two patients had acute urinary retention after PAE, and a temporary bladder catheter was placed for a couple hours. One patient, already mentioned, developed bladder wall ischaemia.

Carnevale et aI. recently published the results of PAE in 11 patients with BPH and indwelling urinary catheter. Ten out of eleven patients urinated spontaneously 4-25 days (mean 12.1 days) after vesical catheter removal. Post-embolization syndrome manifested as mild pain in the perineum, retropubic area and/or urethra. In an asymptomatic patient, there was a hypo perfusion area of bladder suggesting small ischaemia of the bladder that was not detected at 90 days by MR follow-up. After one year, the mean prostatic volume reduction was greater than 30%. There was symptoms improvement of IP55 (2.8 + 2) and Qol (004 + 0.5).

 

Procedure times

The procedure fluoroscopy time of the first 2 patients reported by Carnevale were 160/59 mins and 250/95 mins, respectively. Both patients were discharged 3 days after PAE. At CIR5E 2012, Carnevale reported an average of 2 hours for PAE. In our first reported 15 cases, the PAE procedure lasted between 25 and 135 minutes (mean 85 mins) and fluoroscopy time ranged between 15 and 45 minutes (mean 35 mins). Ali patients were treated as out­ patients; 12 were discharged from the hospital 6-8 hours after the procedure and the remain­ing 3 patients 18 hours after, the next morning. In our recent publication the PAE procedure lasted 25-185 minutes (mean 86 mins) and the fluoroscopy time was 7-63 minutes (mean 27 mins). 78 of the 86 patients (91%) were dis­charged from the hospital 6-8 hours after the procedure and the remaining 8 patients were discharged the following morning, 18 hours after PAE. The radiation dose of each patient ranges from 2.121 to 9.766 dGy cm2 (mean 3.050 dGy cm2).

 

Conclusion

In conclusion, it is very important to know the prostatic arteries anatomy through previous Angio-CT or Angio-MR in order to plan the procedure in advance and reduce the procedure and fluoroscopy time.

Today, more than 500 patients with BPH have been treated with PAE around the world with good and satisfactory results at both short and medium-term follow-up. In Europe, the United

States and Brazil there are already several centres performing PAE. As of April 2013, we have treated over 400 patients with BPH, 17 of them with at least 3 years’ follow-up. Although we work with urologists, we have a lot of patients coming directly to us to be evaluated due to the results of the technique.

The data available in the literature are still limited and multicentric and more randomized studies are needed. With the results from two centres we can see a real benefit of PAE in selected patients with BPH.

Interventional News (Agust 2013)

tiago

Particle size for prostate embolization: Is smaller better?

Tiago Bilhim, interventional radiology, Saint Louis Hospital, Lisbon, Portugal, presented the results of a randomised prospective study which compared 100µm with 200µm polyvinyl alcohol particles (PVA) for prostatic artery embolization at the Society of

Interventional Radiology annual meeting (13-18 April, New Orleans, USA)

In the study, Bilhim said, patients with benign prostatic hyperplasia underwent prostatic artery embolization with either one of two different sizes (I Oüum and 200llm) of polyvinyl alcohol particles. The primary endpoint was to evaluate the clinical outcome; the secondary outcome was to evaluate the pain severity and the complication rates between the two sizes.

Eighty patients, from May to December 2011, underwent prostatic artery embolization. Half of the cohort was embolized using 100µm and the other half was embolized using 200µm particles.

Bilhim told delegates that pain was measured on a scale of O to 10 during embolization, four to eight hours after the procedure and a week post procedure. The complication rates that occurred with the two particle sizes were also prospec­tively compared.

He reported that overall 16 patients were lost to follow-up. ln the 100µm cohort, post embolization, the overall mean pain score was 0.1, mean improvement in the lnternational Prostate Symptom Score (IPSS) and Quality of Life scores were 7.1 and 1.4, respectively.

In the 200llm group, the mean post-embolization pain score was O and the IPSS and Quality of Life mean improvement scores were 10.8 and l.9, respectively.

According to Bilhim, there was no statistical significant difference between the groups with respect to the minor complication rates or pain. No major complica­tions were observed in the study cohort.

“The clinical outcome at six rnonths was better after prostatic artery embolization for benign prostatic hyperplasia with 200µm polyvinyl alcohol particles, but there was greater prostate volume and prostate-specific antigen reduction with 100µm polyvinyl alcohol particles. The combination of 100µm plus 200µm polyvinyl alcohol particles may be the best option for prostatic artery embolization,” he said.

Bilhim told lnterventional News, “Usually size is chosen based on the anatomy found, upsizing when large anastomoses between the prostatic and surrounding arteries are found. Larger polyvinyl alcohol particles (200llm) could be expected to decrease the risk of untargeted embolization, pain and adverse events.

Also, it is reasonable to assume that smaller-sized particles (100µm) may lead to a better clinical outcome due to a greater ischaemia with a more distal penetration into the prostate.

However, there was no evidence until now that smaller particles would lead to a better clinical outcome or to higher rates of pain or adverse events. This is the first study to show that smaller sized polyvinyl alcohol particles are as safe as larger sized ones for prostate embolization. Smaller sized particles probably induce greater prostatic necrosis that may explain the higher prostate volume and prostate-specific antigen reductions. Larger sized polyvinyl alcohol particles may prevent revascularization and, hence, lead to better clinical outcomes. Starting prostate embolization with 100µn polyvinyl alcohol particles and finishing with 200llm polyvinyl alcohol particles is probably the best option with this type of embolic agent.

Bilhim also noted that the results of this study are “in press” and scheduled for publication in one of the forthcoming issues of the Journal 01 Vascular and interventional Radiology.

Interventional News (Agust 2013)

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Outcomes of prostatic artery embolization in 2013

In our experience, there are about 10-15% of early clinical failures. If the anatomy of the prostatíc arteries is not difficult and if the patients do not have advanced atherosclerotic changes, prostatic artery embolization can be repeated three to six months later, writes João Martins Pisco.

In spite ofthe excellent results of uterine fibroid embolization and its similarity to prostatic artery embolization the first case of prostatic artery embolization was performed only in 2000 by DeMeritt in a patient with acute urinary retention and persistent hematuria, with clinical success. This delay was due to the complex anatomy of the prostatic arteries and the fear of sexual dysfunction.

At SIR 20 I O, we presented the preliminary results in the first 12 patients. The procedure was successful in II ofthe 12 patients (90.9%). Due to the good results, from the beginning, we mentioned that the procedure feasible, with low morbidity, no sexual dysfunction and an alternative to medical and surgical treatment for benign prostatic hyperplasia.

“We had only one major complication, a small bladder ischaemia that was treated by surgery, but the patient remained very happy because his sexual life improved a lot”

ln the meantime, our team published several papers and amongst them the results in 14 patients in the Journal of Vascular and lnterventional Radiology (JVI R) in 20 11, 89 cases in Radiology and 255 patients in the European Journal of Radiology. ln the last paper, the cumulative rate of clinical success at 36 months was 72%. We had only one major complication, a small bladder ischaemia that was treated by surgery, but the patient rernained very happy because his sexual life irnproved a lot.

In regards to minor complication, 9.2% patients mentioned a burning sensation in the urethra andJor in the anus during the procedure, and 7.6% had urinary tract infections after embolization. Transient haematuria occurred in 5.6% patients, transient haematosperrnia in 0.4%, a small rectorrhagia in 2.4% and balanitis in 1.6%. Ali these rninor complications disappeared spontaneously, without any treatment. Six patients had transient acute urinary retention after prostatic artery ernbolization. For relief, a ternporary bladder catheter was placed at the time for a couple of hours. We have now over 500 patients treated for benign prostatic hyperplasia and moderate to severe lower urinary tract syrnptorns (LUTS). The total number of treated patients around the world is about 700 if one includes patients treated by Carnevale and others treated in other centres. We have now 267 patients treated over one and a half years, 29 treated over three years and nine patients treated over four years. With experience, our results have improved and the medi um- and long­term results are about 75%.

In our experience, there are about 10-15% of early clinical failures. Ir the anatomy of the prostatic arteries is not difficult and if the patients do not have advanced atherosclerotic changes, prostatic artery embolization can be repeated 3-6 months later. Most clinical improvements occur almost immediately, and up to one month. Very few patients improve up to three months.

Although prostatic artery embolization is not a procedure to irnprove sexual function, it may result in an improvement in sexual function in about a third of the patients. This may be explained by the withdrawal of the prostatic medication, the irnprovernent in urinary symptoms and quality of life. Prostatic artery embolization compares favourably with surgery where retrograde ejaculation is very frequent.

Most of our patients have been treated using polyvinyl alcohol, but we are doing studies with various ernbolic agents such as Bead Block, Embozene and Embosphere. So far, ali ernbolic agents work. Prostatic artery ernbolization is a multidisciplinary procedure and done in conjunction with urologists. l n 2013, I can confirrn my initial thoughts that prostatic artery embolization is a procedure with future and in three to five years it will probably be the rnain treatment for benign prostatic hyperplasia. However, we need to demonstrate the safety and good results of the procedure in order for it to be accepted by urologists.

João Martins Pisco is professor at the Faculty of Medical Sciences, New University of Lisbon, Portugal. He has a consultancy agreement with Cook Medical

Interventional News (June 2012)

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Prostatic artery embolization sparks widespread interest at interventional radiology meetings life in a selected group of patients with acute urinary retention, he said.

Camevale and colleagues carried out a prospective, single site, phase 2 study that included LI patients with acute urinary retention due to benign prostatic hyperplasia who had been managed by medical treatment and indwelling urethral catheters and who were waiting for transurethral resection of the prostate (TURP). International Prostate Symptom Score (IPSS) ranging from best to worst (range, 0-35), Quality of life questionnaires and urodynamic testing were used to assess the outcome. Patient age ranged from 59 to 78 (mean 68.5 years) and prostate weight ranged from 30 to 90 grams. Patients underwent physical examination, prostate specific antigen measurement, transrectal ultrasound and MRI.

“Twelve prostatic artery embolization procedures using 300-500 µm Embospheres were performed in 11 patients under local anesthesia. Technical success (bilateral embolization) was 75% and clinical success (catheter removal and symptoms improvement) was 91 % (10/11 patients). Patients urinated spontaneously from four to 25 days (mean, L2.1) after catheter removal. The most frequent, related symptoms due to the procedure were mild pain. No major complications were observed. Minimum rectal bleeding was observed in 3/12 (25%), diarrhoea in 2/12 (16.6%) and focal bladder ischaemia in 1/12 (8.3%) procedures. Follow-up ranged from 16 to 45 months,” said Carnevale.

He also said, “Most importantly, gland shrinkage was observed during the initial six month follow-up and both ultrasound and MRI showed a mean of 30% volume reduction in the prostate size until the last imaging follow-up. Clinical overall improvement in lower urinary tract symptoms at one-year follow-up was observed, assessed by IPSS (mean, 2.2) and quality, of life (mean, 0.25) and the urodynamic data corroborate the clinical improvement. Ali patients have higher urinary flow and reduced detrusor pressure compared to the pre-embolization urodynamic study and reported a high degree of satisfaction after prostatic artery embolization.”

 

“Although these prelirninary results are very promising, it must be noted that prostate artery embolization is an extreme­ly advanced embolization procedure requiring rigorous training and a detailed knowledge of the prostate anatomy and surrounding vessels,” said James B Spies, Washington DC, USA.

Live case at GEST 2012 US

In early May, GEST 2012 US delegates had the chance to witness “first-hand” via a live transmission from the University of São Paulo Medical School and Sirio Libanes, São Paulo, Brazil, the first-ever live transmission of a prostatic artery embolization procedure for benign prostatic hyperplasia. Carnevale told delegates about the specifics of the case in New York. The embolization was performed in Brazil by Joaquim Maurício da Motta-Leal-Filho, Airton Mota Moreira and Octavio Galvão.

“The patient is a 60-year-old with no comorbidities who has taken medication for benign prostatic hyperplasia for the past five years. He has refractory lower urinary tract symptoms but no urinary infection or acute urinary retention. The main lower urinary tract symptoms include urinary hesitancy, weak urinary stream, urinary urgency and nocturia. The patient has a severe IPSS of 26 and a low quality of life score of five,” he said.

He also noted that a digital rectal exam had revealed a 70g prostate with no nodules; urodynamic testing had shown an infravesical obstruction and that the peak urinary flow rate (Qmax) was 6.5mL/second. In this case, the materials used for embolization were a 5F sheath pigtail and vertebral catheter (from Merit Medical), a microcatheter, the Renegade STC angled (from Boston Scientific), a microwire, Fathom 0.016″ (from Boston Scientific) and 300-500J..Ull Embospheres (from Merit Medical). “The endpoint of the procedure was slow flow, or near stasis in the prostatic vessels,” Carnevale noted.

GEST 2012 US delegates experts debated about the best candidates for the procedure, the different techniques currently employed, the most useful imaging modality, and different embolic agents used for this novel procedure. They also heard about medical and surgical therapies and their limitations, the pre-embolization work-up, prostatic arterial anatomy, and results of the procedure. The importance of working in a multidisciplinary team with good co-operation with urologists was also highlighted.

While Carnevale’s group in Brazil is one of the groups pioneering the procedure, João Pisco’s group in Lisbon, Portugal, is another pioneering centre. Delegates at GEST heard about embolization techniques from both centres.

 

Lisbon experience

In his talk on pre-embolization work-up, Pisco told delegates that in order to maximize clinical outcomes, interventional radiologists had to perform the correct clinical evaluation and select the right patients. “ln my view, a good candidate for embolization is a patient with severe symptoms (lPSS> 18; a low flow rate [Qmax<12mLls], proven outlet obstruction and a very large prostate). It is very important to explain the procedure clearly to patients, ensuring that its experimental nature and uncertain clinical outcome are clearly discussed. There is an approximately 25% clinical failure associated with the procedure and patients should be able to choose between prostatic artery embolization, resection or thermotherapy such as laser,” he said.

“The major advantage of embolization is that it is a minimally invasive procedure with minimal morbidity, no sexual dysfunction, rapid recovery, patients have rapid recovery and that it is an outpatient procedure.

“ln our centre, we excluded 50% of patients for not having severe lower urinary tract symptoms, 10% for having cancer, and 5% for not having suitable anatomy or for atherosclerotic changes. Similarly, 5% are excluded for having bladder problems.

So, only 30% of patients from our outpatient clinic have suitable indications for prostatic artery embolization.

“It is important to emphasise that the results of prostatic artery embolization are not always predictable. Patients who have the same prostate volume reduction can have different outcomes. In some cases, despite there being a decrease in prostate volume, there is no improvement in symptoms. Patients should be informed of unpredictable results even with good embolization,” reiterated Pisco.

He also shared the Lisbon team’s results with the prostatic artery embolization in 262 patients. Pisco’s team achieved technical success, defined as embolization of at least one prostatic artery, in 257/262 (98.1 %) of cases. Bilateral embolization was carried out in 238/262 (90.8%) of cases. Of these, complete embolization was seen in 221/238 patients (92.9%) of patients and incomplete embolization was seen in the remainder 17/238 (7.1 %). Unilateral embolization was carried out in 24/262 cases (9.2%). There were 5/262 (1.9%) cases of technical failure, which was defined as non-embolization of any of the prostatic arteries. The Lisbon team uses polyvinyl alcohol as the embolic agent. In the Lisbon data the mean procedure time was 85 minutes (25-85 minutes). The mean fluoro time was 35 minutes, and procedure was an outpatient one in 246/262 (93.9%) of patients.

Some of the catheter-related complications were inguinal haematoma, bruising, arterial dissection, arteriole rupture and in one patient, there was small bladder wall ischaemia. Other complications seen were urethra burning (18), urinary tract infection (16), transient urinary retention (4), severe pain (one patient who had bladder ischaemia), light to moderate pain was felt by 3-5/ patient sand 10-18 patients. There were also cases of haematuria (5), haernosperrnia (6), rectal bleeding (4) and balanites (2).

Follow-up was carried out by the Lisbon team. Clínica I follow-up was assessed using the IPSS, QoL and IIEF, Urodynamic follow-up was by Qmax and post void residual volume (PVR), and prostate volume and prostate specific antigen were checked at one, three and six months. After that, follow-up was every six months after the procedure. The team has a follow-up period ranging from one to 36 months (mean 14.8 months).

Pisco reported that their results showed that in their study on average IPSS decreased by 10.1 points (p<0.000 I); quality of life scores changed by 1.7 points (p<O.OOOL); international index of erectile function scores went up by 1.1 points (p=0.13). The mean prostate volume decreased by 18mL (p<0.000 I); Qmax increased by five mL/s (p<0.0001) and mean PSA decreased by 2ng/ml (p=0.002).

However, Pisco told delegates that poor clinical outcome at 24 months was observed in up to 30% of patients. “These correlated with a higher baseline PVR; unilateral ernbolization; and was observed in patients who did not experience prostate volume reduction. There is no reduction of prostate volume in 26% of patients and this more likely after unilateral embolization,” he said.

A poor outcome is observed after embolization if any one of the following criteria hold true Pisco explained: Reduction of IPSS<25% and/or score above 18; quality of life: ≤ 4 and reduction of less than one point; Qmax increase, but to less than 2.5mL/s, and if an additional treatment is required.

At GEST 2012 US, Marc Sapoval, Paris, France, said “We must avoid adding costly imaging to the procedure, and keeping the patient in hospital too long. Our technique must be absolutely sound; it is important that there are no technical mistakes, and all complications need to be avoided. TURP is the gold standard, the benchmark for surgical therapy and embolization will have to be measure up to this procedure.”

He added, “The surgical option is a basic endoscopic procedure that urology residents learn and is also one of the bread and butter operations that most urologists perform. It is efficient, cost-effective and durable with a low, long-term complication and re-treatment rate. We have a lot of work ahead of us to make embolization a recognised alternative to TURP. We have to learn all aspects of the disease.

Eventually, we will need a randomised controlled trial against TURP and future studies will have to assess cost-effectiveness. Importantly, one of the winning factors in favour of embolization is that there is no risk of loss of sexual function with embolization. Impotence and retrograde ejaculation can be complications related to surgery,” he said.

Diário de Notícias “Novo tratamento para a próstata atrai doentes e médicos estrangeiros”
Boas Notícias – “Portugal tem tratamento à próstata único no mundo”
Correio da Manhã – “Técnica trata tumor da próstata”

Faça download do artigo
March 22, 2011
Press Conference in Chicago
Press Release:
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 List of Publications After Press Release:
Jornal i, 10 Abril 2011 – “Técnica lusa resolve doença da próstata”
Canal de Moçambique 4 Agosto 2010 – “Já não é preciso recorrer à cirurgia”
Notícias Médicas – “Embolização das Artérias Prostáticas”

Correio da Manhã – ” Conselheiro europeu defende técncia lusa”
SOL – “Portugal inova no tratamento da próstata”

Jornal de Noticias 22 Julho 2011 – “Tratamento Inovador da Próstata”
Correio da Manhã 31 Julho 2011 – 4300 euros  para tratar a próstata
14 August 2011  – “Mensch & Medizin” –  Article Published in the Neue Zuercher Zeitung
Interventional News – March 2012
Endovascular Today – April 2012
Daily Mail – April 2012
Interventional News – June 2012


Diário de Notícias – Radiologistas portugueses ganham melhor artigo científico
Sapo – Tratamento inédito à próstata desperta interesse mundial
Expresso – Tratamento inédito à próstata desperta interesse mundial
Público – Tratamento inédito à próstata desperta interesse mundial
Jornal de Notícias – Tratamento inédito à próstata desperta interesse mundial
Expresso Online – Médico português anuncia tratamento revolucionário da próstata
Outpatient Procedure Shows Promise for BPH
SIR: Embolization Promising for BPH
Enlarged Prostate: Breakthrough In Minimally Invasive Treatment
Enlarged Prostate: Latest Study Shows New Treatment Low Risk and More Effective – Full Report
SIR: Method Effective for Benign Prostatic Hyperplasia
The future of treatment for an enlarged prostate?
Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia
New Surgery-Free Treatment for Enlarged Prostate Avoids Sexual Dysfunction
No Scalpel: Minimally Invasive Breakthrough for Men’s Enlarged Prostates Improves Symptoms
Researchers Present Minimally Invasive Advances in Treatment
Prostatic artery embolization
Procedure to shrink prostate shows promise
Method Effective for Benign Prostatic Hyperplasia

 

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Comentários: 3

  1. Philip Rink says:

    I would like to apply for Dr. Joao Martins Pisco’s PAE procedure, and I will be happy to travel to Lisboa for that.

    Please let me know if that is possible. I have been living with BHP for about 8 years, and I do not use medication, just mild herbal supplements. My condition is not severe, but the “P” rating is 14 and has been steady for years. I get it checked once a year. I take no drugs of any kind, and my blod pressure is normal.

  2. baret jean-michel says:

    Bonjour,
    J’ai lu dans une revue de santé naturelle, la possibilité de traiter l’adénome bégnigne de la prostate par le professeur PISCO, pouvez-vous me dire si cette technique est pratiquée en france et si oui par qui et surtout à quel endroit? Merci d’avance
    Cordialement
    JM BARET

  3. elizabetep says:

    C’est pratiqué par Professeur Marc Sapoval á Paris, George Pompidou Hospital.

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