Comparing embolic particles for prostatic artery embolization to treat lower urinary tract symptoms in patients with benign prostatic hyperplasia

PurposeCompare the safety and efficacy of polyvinyl alcohol particles (PVA) versus trisacryl gelatin microspheres (Embospheres) versus hydrogel microspheres coated with polyzene-F (Embozenes) for prostatic artery embolization (PAE) to treat patients with benign prostatic hyperplasia (BPH).Materials and methodsA single-center prospective cohort study from 2019 to 2023, including patients with international prostate symptom score (IPSS) >= 15 and/or quality of life score (QoL) >= 4. Allocation to embolic agents was performed chronologically: 100-300 mu m PVA (n = 53), followed by 300-500 mu m Embospheres (n = 50), and finally, 400 mu m Embozenes (n = 50). All patients were evaluated at baseline and at 1 and 6 months after PAE with IPSS/QoL; peak urinary flow rate, post-void residual volume, and prostate volume with ultrasound and prostate-specific antigen. Adverse events and the need for prostatic re-interventions were assessed.ResultsThere were no significant baseline differences between the three groups except for patient age (62.5 years PVA; 66.1 years Embospheres and 66.6 years Embozenes; p = 0.019). There were no major adverse events and no differences between groups regarding minor adverse events. All outcome measures improved significantly from baseline, with no significant differences between groups. Mean +/- standard deviation IPSS/QoL improvement at 6 months: -10.7 +/- 7.9/-2.2 +/- 1.7 PVA; -10.4 +/- 7.3/-2.0 +/- 1.5 Embospheres; -10.4 +/- 7.0/-2.2 +/- 1.6 Embozenes (p = 0.987). Re-intervention rates after 6 months: 9% (n = 5/53) PVA; 14% (n = 7/50) Embospheres; 8% (n = 4/50) Embozenes (p = 0.591).ConclusionsPAE with PVA particles, Embospheres, and Embozenes is equally safe and effective in treating BPH-related lower urinary tract symptoms.Clinical relevance statementThis is the first prospective study showing equivalence between the most frequently used embolic agents for prostatic artery embolization.