Prostatic artery embolization as a method for prevention of infravesical obstruction after low-dose-rate brachytherapy

BACKGROUND: Infravesical obstruction in patients with localized prostate cancer caused by concomitant benign prostatic hyperplasia substantially limits the feasibility of low-dose-rate brachytherapy. Traditional methods of obstruction correction, particularly transurethral resection of the prostate, are associated with a risk of postoperative complications and complicate the technical performance of radioactive seed implantation. Therefore, the search for new approaches to patient preparation for low-dose-rate brachytherapy is of considerable clinical relevance.

AIM: This work aimed to evaluate the effectiveness of prostatic artery embolization in patients with prostate cancer and concomitant infravesical obstruction due to benign prostatic hyperplasia prior to low-dose-rate brachytherapy.

METHODS: The study included 49 patients with localized prostate cancer and symptoms of infravesical obstruction caused by benign prostatic hyperplasia who were scheduled for low-dose-rate brachytherapy. According to the method of preparation for low-dose-rate brachytherapy, patients were allocated into two groups: group 1 received prostatic artery embolization; group 2 received prostatic artery embolization combined with androgen deprivation therapy. The effectiveness of embolization was assessed based on changes in uroflowmetry parameters, prostate volume, and postvoid residual urine volume. Upon achieving satisfactory voiding parameters (Q_max ≥ 15 mL/s, postvoid residual urine volume ≤ 50 mL), low-dose-rate brachytherapy was performed. The analyzed parameters were assessed before embolization, 1 month after embolization, and 12 months after brachytherapy.

RESULTS: After prostatic artery embolization, a substantial reduction in prostate volume and improvement in urinary function were observed, including decreased postvoid residual urine volume and increased urinary flow rate. Significantly greater positive changes in the assessed parameters were observed in the combined preparation group (prostatic artery embolization + androgen deprivation therapy). Low-dose-rate brachytherapy was successfully performed in 18 patients from both groups. Following prostatic artery embolization, spontaneous voiding was restored in 4 of 5 men who had previously undergone cystostomy, which allowed removal of the cystostomy drainage and subsequent low-dose-rate brachytherapy. No episodes of acute or chronic urinary retention were observed in the post-implantation period.

CONCLUSION: Prostatic artery embolization can be used to reduce prostate volume and improve urinary function in patients with prostate cancer and infravesical obstruction caused by benign prostatic hyperplasia prior to low-dose-rate brachytherapy. This method reduces the severity of infravesical obstruction and decreases the risk of acute and chronic urinary retention in the post-implantation period.