Long-term Outcomes of Prostatic Artery Embolisation: A Nationwide Prospective Cohort Study

Background and objective: Lower urinary tract symptoms (LUTS) can severely impair quality of life in men. Prostatic artery embolisation (PAE) is a safe and effective treatment for LUTS. This study aims to assess the complications, treatment effects, and reintervention following PAE. Methods: A multicentre prospective cohort study was conducted using cross-sectional long-term questionnaires, including all PAE patients from 2017 to 2022. PAE was performed in an outpatient setting under local anaesthesia. An interventional radiologist embolises under fluoroscopic guidance, inducing ischaemia and subsequent prostate shrinkage. Adverse events (AEs) and serious adverse events (SAEs) were reported 90 d after PAE. Outcomes were evaluated by the Danish Prostate Symptom Score (DAN-PSS), transrectal ultrasound, uroflowmetry, and urinary catheter cessation. Retreatment was estimated by the Aalen-Johansen estimator. Key findings and limitations: A total of 336 patients were included; the median age was 72 yr (interquartile range [IQR] 66–76 yr), the median prostate volume was 101 cm³ (IQR 81–147 cm³), 88 (26%) were catheter dependent, and the median DAN-PSS of the remaining patients was 30 points (IQR 23–44). An SAE occurred in 26 (7.7%) patients; 132 (39%) experienced postembolisation syndrome and 106 (32%) another minor AE. At 0–6 mo of follow-up, the median DAN-PSS was 6 points (IQR 1–16) and 53/88 (60%) of catheter-dependent patients were catheter free. At >2 yr of follow-up, the median DAN-PSS was 9 points (IQR 3–21). The reintervention rates were 9.5% (95% confidence interval [CI]: 6.3–13%) at 2 yr and 18% (95% CI: 11–25%) at 5 yr. The questionnaire response rate was 79%. The limitations include a lack of proper follow-up data and no control cohort. Conclusions and clinical implications: PAE was proved to be safe, effective, and durable for selected patients in Denmark with severe LUTS, catheter dependency, and large prostates. During the 5-yr follow-up, 18% of patients required retreatment, a finding that should be interpreted in the context of their initially limited treatment options.