Prostatic artery embolization (PAE) yields greater clinical benefits than combined medical therapy in men with benign prostatic hyperplasia (BPH) not helped by alpha blocker monotherapy.
In the PARTEM trial (ClinicalTrials.gov identifier: NCT02869971), investigators assigned 44 men from 10 hospitals in France to PAE and 43 men to at least 9 months of daily oral dutasteride (0.5 mg) plus tamsulosin hydrochloride (0.4 mg). At enrollment, the men had an International Prostate Symptom Score (IPSS) greater than 11, a quality of life score greater than 3, and a prostate volume of 50 mL or more.
At 9 months, the PAE group experience a greater mean baseline-adjusted difference in IPSS compared with the combined drug therapy group: 10.0 vs 5.7 points. The mean baseline-adjusted difference between the 2 groups at 9 months was 4.4 points, Marc Sapoval, MD, PhD, of Hôpital Européen Georges Pompidou in Paris, France, and colleagues reported in The Lancet Regional Health. The reduction in storage and voiding IPSS scores was also greater with PAE: mean between-group difference ̶ 2.0 and ̶ 2.4, respectively. Quality of life improved after the procedure. Neither large prostate volume greater than 80 g nor severe urinary symptoms influenced these outcomes.
Continue Reading
The International Index of Erectile Function (IIEF-15) score also improved by 8.2 points with PAE, whereas it decreased by 2.8 points with combined therapy, the investigators reported.
The investigators observed no treatment-related adverse events or hospitalization. After 9 months, however, 5 patients in the PAE group and 18 patients in the combined therapy group required prostate re-treatment. At 24 months, 18 patients in the combined therapy group compared with 2 patients in the PAE group required invasive treatment.
“This trial demonstrates that, at 9 months and up to 24 months, PAE provides better urinary and sexual symptoms score benefit than combined therapy in patients with bothersome LUTS related to BPH ≥50 ml not responsive to a one-month trial of alpha blockers,” Dr Sapoval’s team concluded.
Reference
Sapoval M, Thiounn N, Descazeaud A, et al; PARTEM study group. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. Lancet Reg Health Eur. 2023;31:100672. doi:10.1016/j.lanepe.2023.100672