Purpose
Compare 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 methods
A 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 µm PVA (n = 53), followed by 300–500 µm Embospheres (n = 50), and finally, 400 µm 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.
Results
There 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).
Conclusions
PAE with PVA particles, Embospheres, and Embozenes is equally safe and effective in treating BPH-related lower urinary tract symptoms.
Clinical relevance statement
This is the first prospective study showing equivalence between the most frequently used embolic agents for prostatic artery embolization.
Key Points
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Different particles can be used interchangeably for prostatic artery embolization.
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The improvements in measured metrics were the same between groups, with no differences in adverse events.
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The need for prostatic medication and re-intervention rates were the same at 1 and 6 months after embolization.
