47 - Pre-Procedural Predictors of n-Butyl Cyanoacrylate Prostate Artery Embolization Clinical Non-Responders

Purpose: Prostate artery embolization (PAE) is a safe and effective minimally invasive treatment for patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, limited data exists to guide patient selection by identifying predictors of treatment failure when n-butyl cyanoacrylate (n-BCA) is used as the primary embolic. This study aims to identify pre-procedural factors associated with clinical non-response after PAE with n-BCA.

Materials and Methods: A retrospective analysis was conducted on 198 patients who underwent n-BCA PAE between 8/2022-3/2024. Clinical non-response was defined as < 5-point reduction in International Prostate Symptom Score (IPSS) or need for repeat interventional/urologic treatment within 1 year. Patients lost to follow-up were excluded. Non-responders were matched with responders by age and baseline IPSS using propensity score matching. Pre-procedural imaging parameters, including prostate urethral angle (PUA), prostate volume (PV), intravesical prostatic protrusion (IPP) of the median lobe, and bladder wall thickness (BWT) were compared using univariate analysis.

Results: A total of 104 patients met inclusion criteria; 27 (26%) were non-responders. Mean age was 77 years with baseline IPSS 16 among non-responders, and 75 years with baseline IPSS 17 among matched responders. On univariate analysis, larger PV (p< 0.01), greater IPP of the median lobe (p=0.03), and higher PUA (p< 0.01) were significantly associated with treatment response. Non-responders demonstrated greater BWT, although this did not reach statistical significance (p=0.1).

Conclusion: Pre-procedural imaging features, including larger prostate volume, IPP of the median lobe, and higher prostate urethral angle, were significantly associated with clinical response after n-BCA PAE. These imaging characteristics may serve as valuable tools for refining patient selection and counseling patients regarding expected outcomes after embolization.