Early Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study

Early Results of Unilateral Prostatic Artery Embolization as a Focal Therapy in Patients with Prostate Cancer under Active Surveillance: Cancer Prostate Embolisation, a Pilot Study

To evaluate the feasibility of prostatic artery embolization in patients with low-risk prostate cancer (PC) under active surveillance (AS). This monocentric prospective pilot study, running from June 2018 to June 2019, included 10 patients with low-risk PC under AS, median age 72 years (range, 62–77...

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Bibliographic Details
Published in:Journal of vascular and interventional radiology Vol. 32; no. 2; pp. 247 - 255
Main Authors: Frandon, Julien, Bey, Elsa, Hamard, Aymeric, Mohammad, Hélène, Gonzalez, Samia, Greffier, Joël, Chevallier, Thierry, de Forges, Hélène, Beregi, Jean-Paul, Droupy, Stéphane
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-02-2021
Subjects:
Aged
Embolization, Therapeutic - adverse effects
Feasibility Studies
Humans
Male
Middle Aged
Pilot Projects
Prospective Studies
Prostate - blood supply
Prostatic Neoplasms - blood supply
Prostatic Neoplasms - diagnosis
Prostatic Neoplasms - therapy
Risk Factors
Time Factors
Treatment Outcome
Watchful Waiting
PIRADS
AS
PC
PAE
PSA
QoL
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Summary:To evaluate the feasibility of prostatic artery embolization in patients with low-risk prostate cancer (PC) under active surveillance (AS). This monocentric prospective pilot study, running from June 2018 to June 2019, included 10 patients with low-risk PC under AS, median age 72 years (range, 62–77 years), with a unilateral focal lesion visible on magnetic resonance (MR) imaging, with Prostate Imaging Reporting and Data System v2 score ≥3/5 confirmed by multiparametric MR imaging-targeted biopsy and Gleason score 6. The patients underwent unilateral prostatic artery embolization with 300–500 μm Embospheres in the affected prostatic lobe. The primary endpoint was technical feasibility (prostate and no off-target ischemia in the imaging). The secondary endpoints included safety, negative biopsies/MR imaging response/functional outcomes at 6 months, and oncologic efficacy at 1 year. Embolization was successfully achieved in all patients; prostate ischemia was confirmed on multiparametric MR imaging, and no off-target ischemia was reported. No major complications were reported. Four patients (40%) presented with both negative targeted and systematic biopsies at 6 months. No lesions were seen on the MR imaging in 30% of patients. The mean International Prostate Symptom Score and International Index of Erectile Function score were 7 and 19 and 5 and 20 at baseline and 6 months, respectively, with no significant difference. Nine patients (90%) were still under AS at 1 year. One patient (10%) had PC progression outside the target lesion and was switched over to curative radiotherapy. Prostatic artery embolization is feasible and appears safe for prostate cancer patients under AS, with no impact on erectile function or continence status. These results justify the pursuit of further studies.
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ISSN:1051-0443
1535-7732
DOI:10.1016/j.jvir.2020.10.002