title: Predictors of Clinical Outcome after Prostate Artery Embolization with Spherical and Nonspherical Polyvinyl Alcohol Particles in Patients with Benign Prostatic Hyperplasia.
abstract: Purpose To assess predictors of outcome after prostate artery embolization (PAE) for benign prostatic hyperplasia with spherical particle polyvinyl alcohol (sPVA) and compare outcomes with the use of nonspherical particle polyvinyl alcohol (nsPVA). Materials and Methods This was a single-center retrospective institutional review board-approved study conducted from 2009 to 2015 in patients undergoing PAE with sPVA (n = 186; mean age ± standard deviation, 65.5 years ± 7.7) and nsPVA (n = 300; mean age, 65.3 years ± 7.6). The two cohorts were compared and analyzed for predictors of outcome with a Cox proportional hazards model and linear regression. Post-PAE prostate ischemia was measured with contrast material-enhanced magnetic resonance (MR) imaging in 23 patients with nsPVA and 25 patients with sPVA. The 24-hour post-PAE prostate-specific antigen (PSA) level was registered in 133 patients with sPVA. Prognostic values of MR imaging and PSA levels 24 hours after PAE were assessed with Cox and random-effects regressions. Results Predictors of clinical failure were older age (age over 65 years, P = .002), unilateral procedure (P = .002), and higher baseline International Prostate Symptom Score (IPSS, P = .033). Adjusted hazard ratio for clinical failure of sPVA was 1.273 (P = .16). Acute urinary retention was a predictor of lower IPSS after PAE (P = .002). The mean proportion of prostate ischemia was 11% with sPVA and 10% with nsPVA (P = .65). Lower IPSS after PAE was associated with a higher proportion of prostate ischemia (P = .009). Patients with a PSA level of at least 75 ng/mL (75 μg/L) 24 hours after PAE had a greater decrease in IPSS (P = .01). Prostate ischemic volume and PSA level 24 hours after PAE were correlated (Pearson r = 0.64, P = .014). Conclusion Clinical outcome was similar after PAE with sPVA and nsPVA. Younger age (up to 65 years), bilateral PAE, lower baseline IPSS, and acute urinary retention were predictors of better clinical outcome. The PSA level 24 hours after PAE correlated with prostate ischemia, and both correlated with clinical outcome. (©) RSNA, 2016.
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: Tiago
authors.initials: T
authors.lastname: Bilhim
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: João
authors.initials: J
authors.lastname: Pisco
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: José A
authors.initials: JA
authors.lastname: Pereira
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: Nuno Vasco
authors.initials: NV
authors.lastname: Costa
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: Lúcia
authors.initials: L
authors.lastname: Fernandes
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: Luís
authors.initials: L
authors.lastname: Campos Pinheiro
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: Marisa
authors.initials: M
authors.lastname: Duarte
authors.affiliation: From the Department of Interventional Radiology, Hospital Saint Louis, Rua Luz Soriano n°182, 1200-249, Lisbon, Portugal (T.B., J.P., J.A.P., N.V.C., L.F., M.D.); Departments of Anatomy (T.B.), Radiology (T.B., J.A.P., N.V.C., L.F.), and Urology (L.C.P.), NOVA Medical School and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; and Departamento de Farmácia, Universidade Federal do Rio Grande do Norte, Natal, Brazil (A.G.O.).
authors.forename: António G
authors.initials: AG
authors.lastname: Oliveira
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000627:therapeutic use*; D011379:Prognosis; D011467:Prostate / Q000098:blood supply*; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D011142:Polyvinyl Alcohol; D017430:Prostate-Specific Antigen; D019786:Gadolinium DTPA