Measures that assess prostate volume in patients with benign prostatic hyperplasia (BPH) may be used to predict patient outcome after prostate artery embolization (PAE) surgery, researchers found.
The study, “Prostate Zonal Volumetry As A Predictor Of Clinical Outcomes For Prostate Artery Embolization,” was published in the journal Cardiovascular and Interventional Radiology.
BPH and the associated lower urinary tract symptoms (LUTS) can cause an increase in prostate volume. PAE is a surgical procedure that has been shown to reduce symptoms, improve clinical outcomes and reduce prostate volume safely and effectively. But it was unclear what influence prostate volume had in the clinical outcome of patients who underwent PAE.
Researchers analyzed the medical data of 93 BPH patients (with a mean age of 63.4) with moderate to severe LUTS that had undergone PAE from 2010 to 2014. Medical data included evaluations performed at baseline and six months after the surgery, such as levels of prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), the quality of life (QoL) index assessment, and pelvic magnetic resonance imaging (MRI).
Researchers then compared the whole prostate and central gland volumes, as well as the prostate zonal volumetry index (ZVi) (calculated according to both volumes), with the clinical outcomes of the patients, defined by the IPSS and quality of life at six months after PAE. Clinical failure was defined as an IPSS score above seven or a quality of life score above two.
Results showed that six months after surgery, mean PSA was significantly lower than at baseline, and that clinical failure was reported in only four cases. The researchers also reported a marked reduction in prostate volume after PAE (30.6 percent for the whole prostate and 31.2 percent for the central gland).
The clinical parameters were also improved after PAE, with significant mean decreases in IPSS from 21 to 3.3, a reduction of about 84 percent, and quality of life from 4.7 to 1.2, a decrease of about 74 percent.
Researchers found that a higher whole prostate volume before surgery was significantly correlated to the level of improvement in the quality of life, and a higher central gland volume and ZVi were correlated to the level of improvement in IPSS and quality of life. The higher the reduction after surgery, the better the patients’ outcome. According to the authors, a ZVi above 0.45 predicts better clinical outcomes with 85 percent sensitivity and 75 percent specificity.
“Baseline [central gland] and [whole prostate] volumes as well as ZVi presented strong correlation to clinical outcomes in patients undergoing PAE, and its assessment should be considered in pre-treatment evaluation whenever possible,” the authors wrote.
“Both patients and medical team should be aware of the possibility of less favorable outcomes when ZVi [is above] 0.45. Finally, studies including larger cohorts and longer follow-up periods are still warranted to corroborate such findings,” they added.