139 - Clinical Efficacy of PAE in Men with Radiation Induced Chronic Prostatitis After Definitive Therapy for Localized Prostate Cancer

Purpose: Radiation therapy (RT) is a mainstay of definitive therapy for localized prostate cancer (PCa). Chronic genitourinary (GU) toxicity after RT, which manifests as chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) occurs in up to 33% of men with large volume glands and high baseline lower urinary tract symptoms (LUTS) representing risk factors {1}. CP/CPPS is a challenging condition, with over 50% of cases medically refractory {2}. Prostate artery embolization (PAE) has shown promising early results in men with CP/CPPS from radiation {3}. In this study, we report on clinical efficacy of PAE in a large cohort of this patient population.

Materials and Methods: Single center, single operator retrospective review of 68 men with localized PCa who underwent PAE for RT-induced CP/CPPS between 2017-2025. Baseline International Prostate Symptom Score (IPSS)/ quality of life (QoL) score were recorded at baseline, 6 and 12 weeks, 6 months and annually until 5 years post PAE. Baseline prostate volume (PV) and reduction at 6 and 12 weeks was also reported. Clinical success after PAE was defined as IPSS reduction at least 25% from baseline and absolute score ≤ 15 points, and reduction of QoL at least 1 point from baseline and absolute score ≤ 3. Technical success was defined as at least unilateral embolization to stasis. Adverse events were graded according to standard CTCAE criteria.

Results: Technical success was 93% (n=63) and bilateral embolization was performed in 57% (n=39). Median follow up was 12 weeks. Baseline IPSS/QoL were 22.3/4.8 (range 4-35/2-6) and PV was 58.4 cc (range 12.1-164 cc). Clinical success was 67% (n=35). IPSS/QoL improvement at 6 and 12 weeks, 6 months, and 1, 2, 3, 4 and 5 years was 9.3, 9.2, 11.8, 13.6, 15.5, 17.2, 16.8, 20.7 and 1.9, 2.2, 2.1, 2.9, 3.7, 3.8, 2.8, and 2.7 (p=< .01 for all except QoL at 5 years where p=.09), respectively. PV reduction at 6 and 12 weeks was 36% (n=21) and 32% (n=17) p< 0.002, respectively. One patient had grade 3 adverse event and presented to the emergency room with left lower quadrant pain immediately after PAE of uncertain etiology. Patient was discharged the next day without intervention.

Conclusion: CP/CPPS from RT for localized PCa is a highly morbid condition and over half of cases are refractory to medical therapy. PAE is a novel, efficacious therapy for this condition resulting in improved QoL based on urinary symptoms. Technical aspects of the procedure are more challenging leading to reduced technical success while clinical success is slightly reduced as compared to men with naïve prostates who undergo PAE.