The STREAM Trial (Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia) 24-Month Clinical and
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CLINICAL INVESTIGATION
EMBOLISATION (ARTERIAL)
The STREAM Trial (Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia) 24-Month Clinical and Radiological Outcomes Charles R. Tapping1 • Mark W. Little2 • Andrew Macdonald1 • Tina Mackinnon1 Daniel Kearns1 • Ruth Macpherson1 • Jeremy Crew3 • Phil Boardman1
•
Received: 29 June 2020 / Accepted: 31 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To establish factors predictive of success prior to Prostate Artery Embolization (PAE) with MRI imaging. Materials and Methods A prospective cohort study of 50 patients with Benign Prostatic Hyperplasia (BPH) were treated with PAE in a single institution. Patients had moderate to severe symptoms of BPH refractory to medical management for at least 6 months. Patients were imaged with multiparametric MRI imaging pre-PAE and at 3 months, 12 months and 24 months post-PAE. Clinical success was measured with IPSS, IIEF and EQ-5D-5L quality of life questionnaires. Results The technical success was 48/50 (96%).The mean age of the group was 67 (range 54–83). The mean IPSS score pre-PAE was 21 and at 24 months was 8 (p \ 0.001). There was no deterioration in erectile function. The mean volume of the prostate post-PAE was reduced at 3 and 12 months post-PAE but not significantly different at 24 months. This did not correlate with the IPSS score. Patients with median lobe enlargement has similar symptomatic improvement as those without median lobe enlargement. Internally within the prostate patients with adenomatous-dominant BPH initially did better than patients with stromal enlargement; however, at 24 months patients with stromal enlargement of the prostate improved & Charles R. Tapping [email protected] 1
Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford OX3 7LE, UK
2
Department of Interventional Radiology, Royal Berkshire NHS Foundation Trust, Reading, UK
3
Department of Urology, Churchill Hospital, Oxford, UK
greatest. Initial volume of the prostate was not a good predictor of clinical success. Conclusion PAE is a safe and effective treatment strategy for treating men with BPH. Patients with Adenomatous BPH clinically do better until 12 months but not at 24 months. Initial prostate volume does not affect outcome, and patients with median lobe enlargement do as well as those without. Keywords Prostate Artery Embolization Benign prostatic hyperplasia
Introduction Prostate Artery Embolization (PAE) has established itself as one of the alternative minimally invasive treatments for benign prostatic hyperplasia (BPH) [1] and is now accepted as safe and effective [2]. Performing PAE can be technically challenging, and there is a significant learning curve to perform the technique successfully [3]. A number of groups have looked to ascertain factors important in predicting patients who would benefit from PAE [4, 5]. This is important as there a
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