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Ini’ C, Vasile T, Foti PV, Timpanaro C, Castiglione DG, Libra F, Falsaperla D, Tiralongo F, Giurazza F, Mosconi C, David E, Palmucci S, Lavalle S, Venturini M, Basile A. Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review. J Clin Med 2024; 13:2530. [PMID: 38731058 PMCID: PMC11085005 DOI: 10.3390/jcm13092530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/09/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Benign prostatic hyperplasia (BPH) has a significant impact on the quality of life of symptomatic patients. In patients manifesting lower urinary tract symptoms (LUTS), prostatic arterial embolization (PAE) has become a topic of interest in recent years. The purpose of this systematic review is to analyze and review techniques and clinical outcomes of patients who underwent endovascular treatment of BPH, with a special focus on the comparison of surgical and endovascular procedures. Methods: Through the major scientific databases, 1225 articles were selected from the initial research utilizing specific keywords and medical subject headings. Based on the inclusion and exclusion criteria established for selecting relevant studies for our purposes, the systematic analysis of the literature was conducted on a total of seven articles. Results: We collected data on 718 male patients (408 patients underwent PAE and 310 received TURP). The technical success rate varied from 86% to 100% for TAE and was 100% for TURP. During a 12-month follow-up period, both PAE and TURP were comparable on the reduction in IPSS and QoL questionnaire, while TURP showed significant improvements in Qmax and in the reduction in prostate volume. Length and cost of hospitalization were lower for PAE. Complication and adverse events rates were higher in the TURP group rather than in the PAE group (60.6% vs. 35.5%). Conclusions: Prostatic artery embolization represents an emerging minimally invasive procedure for BPH. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group. Our research strengthens the evidence supporting the effectiveness and safety of PAE as a therapy for LUTS related to BPH.
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Affiliation(s)
- Corrado Ini’
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Tiziana Vasile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
- NANOMED-Research Centre for Nanomedicine and Pharmaceutical Nanotechnology, University of Catania, 95125 Catania, Italy
- Centro di Ricerca Multidisciplinare “Chirurgia delle Sindromi Malformative Complesse della Transizione e dell’Età Adulta” (ChiSMaCoTA), Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy
| | - Concetta Timpanaro
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Davide Giuseppe Castiglione
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Federica Libra
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Daniele Falsaperla
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Francesco Tiralongo
- Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (D.G.C.); (F.L.); (D.F.); (F.T.)
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131 Naples, Italy;
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy;
| | - Emanuele David
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
| | - Salvatore Lavalle
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Enna “Kore” Cittadella Universitaria, 94100 Enna, Italy;
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, Insubria University, 21100 Varese, Italy;
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies “G.F. Ingrassia”—Radiology I Unit, University Hospital Policlinico “G. Rodolico-San Marco”, Via Santa Sofia 78, 95123 Catania, Italy; (T.V.); (P.V.F.); (C.T.); (E.D.); (S.P.); (A.B.)
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Moramarco L, Grande AM, Vertemati M, Aseni P. Prostate Artery Embolization in the Treatment of Massive Intractable Bleeding from Prostatic Neoplasms: A Case Report and Systematic Review. J Clin Med 2023; 13:65. [PMID: 38202072 PMCID: PMC10780233 DOI: 10.3390/jcm13010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Lower urinary tract symptoms (LUTS) and hematuria are common symptoms in men with neoplasms, mainly affecting the elderly population. Prostatic arterial embolization (PAE) is a minimally invasive procedure that has shown promising results in managing LUTS and massive intractable prostatic hematuria in patients with benign prostatic hyperplasia (BPH) and prostate cancer (PCa). A few studies, however, have provided valuable insights into the durability and efficacy of PAE focusing on the long-term effectiveness, quality of life, and cancer-specific control of hemostasis and urinary symptoms. As a result of concomitant cardiovascular conditions, these patients often take anticoagulants or antithrombotics, which can worsen their hematuria and clinical status. Transurethral resection of the prostate (TURP) is considered a very high-risk procedure, even without massive bleeding, and requires discontinuation of vitamin K antagonists and antiplatelet therapies. Such patients usually have their surgery postponed, and PAE should be considered a safe alternative treatment. We aimed to report a narrative review from 1976 to June 2023 of the current state of PAE for massive and intractable hematuria, highlighting recent developments in this technique, including prospective cohort studies, and focusing on long-term outcome, safety, and complication management of patients with prostatic neoplasms who develop significant hemorrhagic symptoms. Additionally, we present a case report and a simple algorithm for treating intractable bleeding in a 92-year-old man with PCa and massive hematuria.
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Affiliation(s)
- Lorenzo Moramarco
- Radiologia—Neuroradiologia Diagnostica ed Interventistica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Antonino M. Grande
- Divisione Cardiochirurgia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Paolo Aseni
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milan, Italy;
- Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda Hospital, 20162 Milan, Italy
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Wang MQ, Zhang JL, Duan F, Yuan B, Xin H, Fu JX, Ye HY, Yu HK, Feng DP, Cheng K, Zhang XJ. Prostate arterial chemoembolization for treatment of refractory hematuria and urinary retention in patients with localized advanced prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:88-95. [PMID: 35249108 DOI: 10.1038/s41391-022-00516-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy transcatheter arterial chemoembolization (TACE) for the treatment of refractory gross hematuria (RGH) and urinary retention (UR) secondary to localized advanced prostate cancer (PCa). PATIENTS AND METHODS Thirty-two patients (mean age 72.5 years, range 60-89) with advanced PCa-related RGH that failed conventional therapy were included. Twenty-two of these patients had catheter-dependent due to PCa-related UR. TACE was performed with epirubicin (EPI)-eluting HepaSpheres (HS) plus intra-arterial (IA) infusion of docetaxel. Technical success, adverse events (AEs), overall survival (OS), control of RGH, removal of indwelling catheters, and local disease control, were evaluated. RESULTS Technical success was achieved in 100% without major AEs. Mean follow up post-TACE was 27 months (range 8-56 months) with a mean OS of 30 months. GRH stopped within 5 days after TACE in all patients, 26 (86.7%) of these patients exhibited good bleeding control during a mean follow-up of 24 months; 17 (77.3%) of the 22 patients with UR had recovered spontaneous urination, 15 (88.2%) patients were catheter-free at their last follow-up with a mean of 24 months. BS was obtained in 73.3% (22/30) of patients at a mean follow-up of 29 months. At the last visit, 22 patients had a mean of 36 months follow-up and the mean percentage reduction in prostate volume was 55.5%, with a statistically different from baseline (P = 0.022). Negative biopsy results were obtained in 84.2% (16/19) of the patients at 12-47 months after TACE. Compared with baseline values, there was a significant improvements in IPSS, QoL, Qmax, and PVR (all P < 0.05). CONCLUSIONS TACE using EPI-eluting HS plus IA infusion of docetaxel is a safe and effective treatment option for the advanced PCa patients with GRH and UR, and it could be considered as an alternative if there was no other therapeutic choice.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China.
| | - Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Hainan Xin
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Jin Xin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Hui Yi Ye
- Department of Diagnostic Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Hong Kai Yu
- Department of Urology, Chinese PLA General Hospital, Beijing, 100853, P. R. China
| | - Dui-Ping Feng
- Department of Oncology and Vascular Intervention, The First Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Kai Cheng
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Xiu Jun Zhang
- Department of Interventional Radiology, Tianjin Nankai Hospital, Tianjin, 300193, China
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Burkhardt O, Abt D, Engeler D, Schmid HP, Müllhaupt G, Zumstein V. Prostatic Artery Embolization in Patients with Prostate Cancer: A Systematic Review. Eur Urol Focus 2023:S2405-4569(23)00045-7. [PMID: 36841710 DOI: 10.1016/j.euf.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/07/2023] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
CONTEXT Prostatic artery embolization (PAE) is increasingly performed worldwide for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). In contrast, the role of PAE in patients with prostate cancer (PCa) is unclear. OBJECTIVE This systematic review summarizes the current available literature on PAE in patients with PCa regarding oncological and functional outcome. EVIDENCE ACQUISITION A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) recommendations. A structured search for the relevant literature from 1985 to 2022 was performed in Medline, Embase, and York CRD. Risk of bias and confounding assessments were performed using the ROBINS tool. EVIDENCE SYNTHESIS Thirteen trials (12 case series and one animal study using a canine model) were included in this systematic review. Four studies had a prospective study design. The risk of bias was rated moderate to serious in all the studies. CONCLUSIONS PAE in patients with PCa seems to be a safe procedure and effective regarding the improvement of LUTS. Despite PAE having been shown to be feasible in different treatment scenarios of localized or advanced PCa, the oncological benefits are debatable due to an unreliable tumor response and a lack of controlled trials including long-term follow-up. PATIENT SUMMARY We investigated the literature to determine the role of prostatic artery embolization (PAE) in patients with prostate cancer regarding oncological and functional outcomes. The results suggest a similar safety profile and efficacy in terms of functional outcomes to those reported earlier for PAE in patients with lower urinary tract symptoms due to benign prostatic hyperplasia. The role of PAE regarding oncological outcomes has to be assessed further.
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Affiliation(s)
- Orlando Burkhardt
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland.
| | - Dominik Abt
- Department of Urology, Spitalzentrum Biel/Centre Hospitalier Bienne, Biel/Bienne, Switzerland
| | - Daniel Engeler
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | | | - Valentin Zumstein
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
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Elmansy H, Hodhod A, Fathy M, Violette PD, Elshafei A, Zakaria AS, Kelly R, Rozenberg R, Alaref A, Abbas L, Abdul Hadi R, Kotb A, Shahrour W. Emergency holmium laser enucleation of the prostate (HoLEP): a novel approach in the management of refractory hematuria for patients with benign prostatic hyperplasia (BPH): a single-institution experience. World J Urol 2023; 41:805-811. [PMID: 36708378 DOI: 10.1007/s00345-023-04292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Refractory hematuria secondary to prostatic disease typically resolves with conservative management; however, this condition may require hospitalization with extensive measures to control life-threatening bleeding. The aim of this study was to report our experience using holmium laser enucleation of the prostate (HoLEP) as an emergency treatment in this clinical setting. METHODS We conducted a retrospective review of all patients that presented to the emergency department with refractory hematuria of prostatic origin from October 2017 to September 2021, for whom hospitalization and conservative management failed to control bleeding. All emergency HoLEP procedures were performed by a single surgeon. Preoperative and intraoperative parameters, as well as perioperative outcomes, were collected and analyzed. Postoperative outcomes included duration of foley catheterization, length of postoperative hospital stay, and hospital readmissions. RESULTS A total of 40 emergency HoLEP procedures were performed. Our cohort had a median prostate volume of 110.5 cc and a median resected weight of 81 g. Twenty-seven patients (67.5%) were on anticoagulant or antiplatelet medications on admission. The urethral catheter was removed within 1 day in 95% of patients with a successful trial of void (TOV). Moreover, 92.5% of patients were discharged home within 24 h of their procedure. Two patients (5%) experienced clot retention within one-week post-discharge with a 2.5% overall readmission rate. All postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and post-void residual volume (PVR), showed significant improvement at 1 year follow up. CONCLUSION Our experience demonstrates that emergency HoLEP is an effective treatment option for patients with refractory hematuria of prostatic origin. Further studies are warranted to consolidate our results.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada.
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada.,Urology Department, Menoufia University, Shebin Elkom, Egypt
| | - Philippe D Violette
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Ahmed Elshafei
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ryan Kelly
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Radu Rozenberg
- Radiology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amer Alaref
- Radiology Department, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, 146 Court Street South, Thunder Bay, ON, P7B 2X6, Canada
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Zhang J, Wang Q, Zhao H, Yuan B, Sun X, Guan Y, Fang Z, Wang M. Safety and efficacy of transcatheter arterial embolization for management of refractory hematuria of prostatic origin. J Interv Med 2022; 5:84-88. [PMID: 35936661 PMCID: PMC9349008 DOI: 10.1016/j.jimed.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To estimate the safety and efficacy of transcatheter arterial embolization (TAE) in the treatment of refractory hematuria of prostatic origin (RHPO). Methods This retrospective study included 23 patients who underwent TAE for RHPO between May 2013 and August 2021. Technical and clinical success rates were calculated, and arteriogram findings and complications were detected. Results Embolization was performed 24 times in 23 patients. Technical success was achieved in 24/24 (100%) embolization procedures. Contrast agent extravasation was detected during 2 of the 24 angiographic procedures. Bilateral embolization was performed in 23 (95.8%) of the 24 procedures. The clinical success rate was 21/23 (91.3%), and hematuria stopped 1–4 days after TAE. No serious complications were observed. Conclusion TAE is a safe and effective minimally invasive technique for treating patients with RHPO.
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Affiliation(s)
- Jinlong Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Quanyu Wang
- Interventional Department, Huabei Petroleum General Hospital, Renqiu, 062552, China
| | - Hongwei Zhao
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Bing Yuan
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xuedong Sun
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Yang Guan
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Zhuting Fang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350122, PR China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, PR China
- Corresponding author. Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350122, PR China; Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, 350001, PR China.
| | - Maoqiang Wang
- Departments of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, PR China
- Corresponding author. Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, PR China
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Deng L, Li C, He Q, Huang C, Chen Q, Zhang S, Wang L, Gan Y, Long Z. Superselective Prostate Artery Embolization for Treatment of Severe Haematuria Secondary to Rapid Progression of Treatment-Induced Neuroendocrine Prostate Cancer: A Case Report. Onco Targets Ther 2022; 15:67-75. [PMID: 35082500 PMCID: PMC8786387 DOI: 10.2147/ott.s345193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Treatment-induced neuroendocrine prostate cancer (t-NEPC) represents a highly aggressive subtype of castration-resistant prostate cancer that commonly arises from prostate adenocarcinoma (AdPC) after continuous androgen deprivation therapy (ADT). However, current treatments for t-NEPC are limited and far from satisfactory. According to our limited knowledge, report regarding the management of t-NEPC related hemorrhage is rare. Here, we report a case of t-NEPC formation after chronic hormonal therapy accompanying with severe bleeding in primary tumor and share our experiences to deal with the severe hematuria resulting from the progression of t-NEPC tumor. Case Presentation An 80-year-old man with a significantly high prostate-specific antigen was diagnosed via pathology as advanced AdPC due to multiple bone metastases. He then received ADT including bicalutamide and goserelin. After 20 months of stable disease, the cancer rapidly progressed and presented with severe gross hematuria caused by bleeding of the primary tumor. The histopathologic analysis of a secondary biopsy of the primary tumor confirmed neuroendocrine prostate cancer, and subsequent genetic testing revealed germ-line mutations in the RB1 and FOXA1. To control the bleeding and relieve symptoms, the patient was treated with superselective prostate artery embolization (PAE). After the left internal pudendal artery and the right prostatic artery were embolized, hematuria was quickly alleviated and disappeared. However, the patient was not a suitable candidate to platinum-based chemotherapy due to weak constitution. Goserelin was continuously applied to maintain castration level of serum testosterone. Meanwhile, palliative radiotherapy to the prostate tumor, high-risk lymph node drainage areas (including iliac and para-aortic lymph nodes, internal iliac lymph nodes, presacral lymph nodes and obturator nerve lymph nodes) and bone metastases (right sacroiliac joint and thoracic vertebra) was performed and relieved the pain. Unfortunately, this patient eventually died of cachexia and multiple organ failure nearly 27 months after initial diagnosis. Conclusion To treat severe hematuria caused by progression of t-NEPC, superselective PAE may be a rapid and efficient way to stop bleeding.
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Affiliation(s)
- Liang Deng
- Andrology Center, Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Chao Li
- Andrology Center, Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Qiangrong He
- Andrology Center, Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Chenghui Huang
- Department of Medical Oncology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Qian Chen
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Shengwang Zhang
- Department of Radiation Oncology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Long Wang
- Andrology Center, Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
| | - Yu Gan
- Department of Urology, Xiangya Hospital of Central South University, Changsha, 410008, People’s Republic of China
- Correspondence: Yu Gan, Department of Urology, Xiangya Hospital of Central South University, 87 Xiang Road, Changsha, Hunan, People’s Republic of China, Tel +86 15111140206, Fax +86 73184327332, Email
| | - Zhi Long
- Andrology Center, Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, 410013, People’s Republic of China
- Zhi Long, Andrology Center, Department of Urology, The Third Xiangya Hospital of Central South University, 138 Tongzipo Road, Changsha, Hunan, People’s Republic of China, Tel +86 13755076226, Fax +86 73188618028 Email
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Prostate Artery Embolization-Review of Indications, Patient Selection, Techniques and Results. J Clin Med 2021; 10:jcm10215139. [PMID: 34768659 PMCID: PMC8584630 DOI: 10.3390/jcm10215139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.
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Wadhwa V, McClure TD. Role of Imaging in Prostate Artery Embolization. Semin Roentgenol 2021; 56:410-415. [PMID: 34688344 DOI: 10.1053/j.ro.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Vibhor Wadhwa
- Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY
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Stężewska A, Stężewska M, Żabicki B, Salagierski M. The application of prostate artery embolization in the management of intractable prostate bleeding. Cent European J Urol 2020; 73:328-335. [PMID: 33133661 PMCID: PMC7587497 DOI: 10.5173/ceju.2020.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Prostate cancer is one of the most common malignancies affecting European men. Sequelae of the advanced malignancy require invasive procedures which may not be eligible especially for old, debilitated patients. The aim of this manuscript is to review the outcomes of prostate artery embolization in the management of refractory bleeding. Material and methods A PubMed database search was done for all English language articles on prostate artery embolization in prostate cancer, published between 2003 and 2019. For current review, information related to number, age of the patients, aetiology of the hematuria, bilateral or unilateral procedure, type of embolic material, technical and clinical success, complications, recurrent hematuria, hematocrit and hemoglobin levels were analyzed. Results A total of 10 original full-text comparative and non-comparative (case series) studies were reviewed. Minor complications described in the literature ranged from 10–50%. After prostate artery embolization, the recurrence of the haematuria occurred in 10–57% of the patients. Moreover, prostate artery embolization successfully treated lower urinary tract symptoms and urinary retention in prostate cancer patients. Conclusions The procedure appears safe, burdened with low risk of complications and accomplishes technical and clinical success. It is a promising option for patients with hemorrhage, but due to the scarcity of data further investigations are needed.
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Affiliation(s)
- Agata Stężewska
- Department of Urology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Magdalena Stężewska
- Department of Urology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Bartosz Żabicki
- Department of Radiology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
| | - Maciej Salagierski
- Department of Urology, Collegium Medicum, University of Zielona Góra, Zielona Góra, Poland
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Anttinen M, Mäkelä P, Nurminen P, Yli-Pietilä E, Suomi V, Sainio T, Saunavaara J, Taimen P, Blanco Sequeiros R, Boström PJ. Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer. Scand J Urol 2020; 54:481-486. [PMID: 32897169 DOI: 10.1080/21681805.2020.1814857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Locally advanced prostate cancer can cause bladder outlet obstruction, gross hematuria and frequent hospitalization. While these complications are commonly treated by palliative transurethral resection of the prostate, the improvement is often insufficient. The purpose of this study was to evaluate the safety and feasibility of MRI-guided transurethral ultrasound ablation as an alternative palliative treatment option (pTULSA) for men suffering from symptomatic locally advanced prostate cancer. METHODS This prospective, phase one study included 10 men in need of palliative surgical intervention due to urinary retention and gross hematuria caused by locally advanced prostate cancer. Patients were followed for 1 year at 3-month intervals. Time without catheter, time without hematuria, reduction in hospitalization time, and adverse events were measured. RESULTS Ten patients with locally advanced prostate cancer were enrolled, all having continuous catheterization due to urinary retention and nine had gross hematuria before treatment. At 1 week post-pTULSA five patients were catheter-free. At last follow-up catheter-free and gross hematuria-free rates were 70% and 100%, respectively. Average hospitalization time from local complications reduced from 7.3 to 1.4 days in the 6 months before and after pTULSA. No > Grade 2 treatment related adverse events were reported, with all five being urinary tract infections. CONCLUSIONS pTULSA appears safe and feasible for palliative ablation of locally advanced prostate cancer. The therapy seems to accomplish long-term hematuria control, can relieve bladder outlet obstruction in selected patients, and seems to reduce the burden of hospitalization due to local complications. Trial Registration Number: NCT03350529.
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Affiliation(s)
- Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pietari Mäkelä
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Eemil Yli-Pietilä
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Visa Suomi
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Teija Sainio
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine and Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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Hashem E, Elsobky S, Khalifa M. Prostate Artery Embolization for Benign Prostate Hyperplasia Review: Patient Selection, Outcomes, and Technique. Semin Ultrasound CT MR 2020; 41:357-365. [DOI: 10.1053/j.sult.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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CIRSE Standards of Practice on Prostatic Artery Embolisation. Cardiovasc Intervent Radiol 2019; 43:176-185. [DOI: 10.1007/s00270-019-02379-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/14/2019] [Indexed: 01/22/2023]
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14
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Ayyagari R, Powell T, Staib L, Chapiro J, Perez-Lozada JC, Bhatia S, Chai T, Schoenberger S, Devito R. Prostatic Artery Embolization in Nonindex Benign Prostatic Hyperplasia Patients: Single-center Outcomes for Urinary Retention and Gross Prostatic Hematuria. Urology 2019; 136:212-217. [PMID: 31734349 DOI: 10.1016/j.urology.2019.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/16/2019] [Accepted: 11/07/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in nonindex benign prostatic hyperplasia patients. MATERIALS AND METHODS Seventy-five patients undergoing PAE from December 2013 to August 2018 (age = 77.5 ± 8.6, age-adjusted Charlson comorbidity index = 4.6 ± 2.0, prostate volume = 224 mL ± 135 mL) for retention (n = 46) and/or gross prostatic hematuria (n = 55) were retrospectively reviewed. Twenty-six patients had both problems. Urinary retention patients (UR, n = 46, catheterization = 162.4 ± 148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and postvoid residual (PVR) recorded at 3, 6, 12, 24, and 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n = 39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n = 16). Ninety-day adverse event tabulation used Clavien-Dindo classification. RESULTS Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS = 8.9 ± 5.3, QoL = 1.6 ± 1.7, PVR = 158 mL ± 207 mL). Results were similar at 6 months (catheter-free = 26/28(93%), IPSS = 6.5 ± 4.4, QoL = 1.1 ± 0.9, PVR = 149 mL ± 139 mL), 12 months (catheter-free = 19/20(95%), IPSS = 4.7 ± 4.8, QoL = 0.6 ± 0.9, PVR = 125 mL ± 176 mL), 24 months (catheter-free = 11/12(92%), IPSS = 4.4 ± 3.0, QoL = 0.9 ± 0.8, PVR = 66 mL ± 68 mL), and 36 months (catheter-free = 5/6(83%), IPSS = 5.8 ± 3.8, QoL = 0.8 ± 1.0, PVR =99 mL ± 71 mL). Out of 37, 34(92%) GH patients remained hematuria-free at 483 ± 137 days, with 22 hematuria-related visits pre-PAE vs none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. Subsequently, 13/16(81%) remained hematuria-free at 500 ± 501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections. CONCLUSION PAE provided safe, effective, and durable treatment for retention and gross hematuria in nonindex benign prostatic hyperplasia patients.
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Affiliation(s)
- Raj Ayyagari
- Yale University School of Medicine, New Haven, CT.
| | | | | | | | | | | | - Toby Chai
- Yale University School of Medicine, New Haven, CT
| | | | - Ralph Devito
- Yale University School of Medicine, New Haven, CT
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Tapping CR, Crew J, Proteroe A, Boardman P. Prostatic artery embolization (PAE) for prostatic origin bleeding in the context of prostate malignancy. Acta Radiol Open 2019; 8:2058460119846061. [PMID: 31218079 PMCID: PMC6563405 DOI: 10.1177/2058460119846061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/12/2019] [Indexed: 12/02/2022] Open
Abstract
Prostate artery embolization (PAE) has been shown to be beneficial in treating men with benign prostatic hypertrophy (BPH). Here we describe treating four patients with prostate cancer (two with organ-confined and two with metastatic prostate cancer) with prostatic bleeding with PAE. Patients had other causes of hematuria excluded and were followed up at 3, 12, and 18 months after PAE. All four cases were technically successful and all cases of hematuria had resolved by the three-month follow-up (100%). There was one case of recurrence at 13 months after PAE which was successfully treated. PAE is useful for controlling significant prostatic bleeding in patients with prostate cancer and improves quality of life. Patients may, however, need repeated treatments to control the bleeding.
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Affiliation(s)
| | - Jeremy Crew
- Department of Urology, Churchill Hospital, Headington, Oxford, UK
| | - Andrew Proteroe
- Department of Oncology, Churchill Hospital, Headington, Oxford, UK
| | - Phil Boardman
- Department of Radiology, Churchill Hospital, Headington, Oxford, UK
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16
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Malling B, Røder MA, Lindh M, Frevert S, Brasso K, Lönn L. Palliative Prostate Artery Embolization for Prostate Cancer: A Case Series. Cardiovasc Intervent Radiol 2019; 42:1405-1412. [DOI: 10.1007/s00270-019-02227-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/19/2019] [Indexed: 12/15/2022]
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17
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Prostatic Artery Embolization for Control of Gross Hematuria in Patients with Benign Prostatic Hyperplasia: A Single-Center Retrospective Study in 20 Patients. J Vasc Interv Radiol 2019; 30:661-667. [DOI: 10.1016/j.jvir.2019.02.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/08/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022] Open
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Tapping CR, Macdonald A, Hadi M, Mortensen C, Crew J, Protheroe A, Little MW, Boardman P. Prostatic Artery Embolization (PAE) for Benign Prostatic Hyperplasia (BPH) with Haematuria in the Absence of an Upper Urinary Tract Pathology. Cardiovasc Intervent Radiol 2018; 41:1160-1164. [PMID: 29582127 DOI: 10.1007/s00270-018-1941-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/18/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the effectiveness of prostate artery embolization (PAE) in the control of haematuria and in patients with benign prostatic hyperplasia (BPH) and normal upper urinary tracts. SUBJECTS/PATIENTS Twelve consecutive patients with haematuria were included in the prospective study. All patients had prior imaging and cystoscopy to exclude other causes of haematuria. Patients prostate arteries were embolized with particles (200-500 μm), and they were followed up at 3, 12 and 18 months following the procedure. QOL questionnaires, IPSS, IIEF and clinical review were all employed to assess the success of the treatment. To allow useful comparison, patients were age- and prostate volume-matched and compared to patients treated with PAE for BPH without haematuria. RESULTS All 12/12 cases were technically successful with bilateral PAE being performed. All cases of haematuria resolved by the 3-month follow-up (100%). There was one case of recurrence during the 12-month follow-up (overall clinical success at 18 months 92%). This was due to over anticoagulation and ceased once corrected. There was a reduction in lower urinary tract symptoms noted by improvements in QOL indices, IPSS and IIEF. There was continued success even if the patient was subsequently anticoagulated. There was no associated sexual dysfunction. There was more prostatic arterial branching and volume of embolic required to achieve stasis in BPH and haematuria than in BPH alone (p < 0.05). CONCLUSION PAE is a very useful technique for controlling the quite debilitating condition of haematuria in patients with visible haematuria of prostatic origin. Controlling haematuria and BPH allows a significant improvement in QOL.
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Affiliation(s)
- Charles R Tapping
- Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK.
| | - Andrew Macdonald
- Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
| | - Mo Hadi
- Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
| | - Chloe Mortensen
- Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
| | - Jeremy Crew
- Department of Urology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
| | - Andrew Protheroe
- Department of Oncology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
| | - Mark W Little
- Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
| | - Phil Boardman
- Department of Radiology, Churchill Hospital, Old Road, Headington, Oxford, OX3 9LE, UK
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Oncological effect of palliative transurethral resection of the prostate in patients with advanced prostate cancer: a propensity score matching study. J Cancer Res Clin Oncol 2018; 144:751-758. [PMID: 29417257 DOI: 10.1007/s00432-018-2597-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE We investigated the oncologic effect of palliative transurethral resection of the prostate (pTURP) in patients with prostate cancer who received primary androgen deprivation therapy. METHODS We reviewed 614 patients, including 83 who underwent pTURP; those with incidental prostate cancer were excluded. Patients were divided into the TURP group and non-TURP group. Propensity score matching was performed for comorbidity, initial prostate-specific antigen (PSA), TNM stage, and Gleason score (GS). The Kaplan-Meier method was used to confirm castration-resistant prostate cancer (CRPC), cancer-specific survival (CSS), and overall survival (OS). Cox regression was performed to confirm factors affecting CSS. RESULTS Before matching, the TURP group had a worse TNM stage (p < 0.01) and GS (p = 0.028) and larger prostate volume (50.1 vs. 39.0 cc, p = 0.005) than the non-TURP group. The most common reason for pTURP was acute urinary retention. After matching, the TURP group showed worse outcomes in CRPC (p = 0.003), CSS (p = 0.003), and OS (p = 0.026). In multivariate analysis, factors for predicting CSS were a positive core percent [hazard ratio (HR) 1.015, p = 0.0272], GS (10 vs. ≤8; HR 6.716, p = 0.0008), and TURP within 3 months after biopsy (HR 2.543, p = 0.0482). The resection weight (HR 1.000, p = 0.9730), resection time (HR 1.000, p = 0.3670), and blood transfusion (HR 0.630, p = 0.1860) were not associated with CSS. CONCLUSIONS The oncologic effect of pTURP as cytoreductive operation seems to be limited. Patients who had to receive pTURP due to cancer-related symptoms, especially early necessity of pTURP (within 3 months after biopsy), showed worse clinical courses; therefore, they should be treated more carefully and actively.
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Niekamp A, Sheth RA, Kuban J, Avritscher R, Ganguli S. Palliative Embolization for Refractory Bleeding. Semin Intervent Radiol 2017; 34:387-397. [PMID: 29249863 DOI: 10.1055/s-0037-1608862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bleeding is a common and often challenging complication of malignancy. Etiologies of hemorrhage in this patient population vary, and bleeding may present as an acute, life-threatening emergency or a chronic, low-volume blood loss. For patients with advanced malignancies, interventions to manage bleeding must be balanced by the patient's life expectancy and quality of life. As such, minimally invasive procedures such as transarterial embolization are useful therapeutic options in appropriately selected patients. There is a rich history of palliative transarterial embolization for refractory bleeding in cancer patients. This technique was first applied in the 1970s and has since become an established treatment tool for malignancy-related bleeding throughout the body. While the preponderance of published data comprised case reports and small retrospective studies, the use of embolization continues to expand as experience grows and techniques are refined. In this review, we summarize the literature and provide our perspective on embolization for refractory bleeding in cancer patients.
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Affiliation(s)
- Andrew Niekamp
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Rony Avritscher
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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