Prostate Artery Embolization Utilization to Allow for Stereotactic Body Radiation Therapy in Men with Prostate Cancer

Purpose: Stereotactic body radiation therapy (SBRT) is a treatment offered to some men with low-grade prostate cancer, but has increased toxicities in patients with larger prostates and/or lower urinary tract symptoms (LUTS). In a subset of SBRT patients, prostate gland volume reduction is traditionally achieved using androgen deprivation therapy (ADT) with the specific purpose of decreasing size of the gland to maximize safety of SBRT. Prostate artery embolization (PAE) is a safe, effective, and well-proven treatment for benign prostatic hyperplasia (BPH) causing moderate to severe lower urinary tract symptoms, particularly in those with large prostates. A retrospective single institution study was performed to evaluate the utility of PAE to treat symptomatic BPH prior to SBRT for low-grade prostate cancer, to allow for SBRT in patients with large prostate glands who otherwise would have needed ADT for gland volume reduction.

Materials and Methods: PAE was performed approximately 3 months prior to SBRT for low-grade prostate cancer. Patients were seen in IR clinic for initial consultation and post procedure to monitor treatment response. All patients had prostate volume (PV) calculated before PAE and 3 months post PAE (ellipsoid model). Other data collected included pre- and post-PAE international prostate symptom score (IPSS) and quality of life score (QoL). Electronic health record review for timing and tolerability of SBRT was performed. Paired t-test was used to compare IPSS, QoL, and PV.

Results: From 3/2018 through 4/2025, 10 patients underwent PAE prior to SBRT and had imaging follow up available. No patients required ADT. Median IPSS, QoL, and PV before PAE was 14.5 (range 13-20), 2 (range 0-4), and 79cc (range 65-165), respectively. Mean improvements in IPSS and QoL at 1 month were 9.9 and 1.9, respectively (p< 0.001 for both). Mean prostate volume reduction 3 months post PAE was 30.6cc (33.4%), p< 0.001. All patients had successful SBRT (725cGy x 5 sessions) without complication.

Conclusion: In patients with BPH and low-grade prostate cancer being treated with SBRT, PAE prior to SBRT can obviate the need for ADT and allow for safe cancer treatment. Utilization of PAE in this scenario needs additional study in larger patient populations, but may be another indication for PAE in the future.