80 - Prostate Artery Embolization in Older Patients: Clinical Outcomes, Safety, and Durability

Purpose: Benign prostatic hyperplasia (BPH) is common in elderly men, with prevalence exceeding 80% by age 80 {1,2}. Surgical therapies such as transurethral resection of the prostate (TURP) or open prostatectomy are often contraindicated in this patient population due to comorbidities and perioperative risks. Prostate artery embolization (PAE) has emerged as a minimally invasive alternative, offering significant symptom relief with lower morbidity {2-4}. This study was done to evaluate the safety, efficacy, and durability of PAE in patients ≥80 years old at a single institution.

Materials and Methods: The authors of this study retrospectively evaluated 34 consecutive patients (mean age 84.7 ± 3.9 years, range 80-94) who underwent PAE between 2015-2024 for lower urinary tract symptoms (LUTS, n=20), urinary retention (n=9), or hematuria of prostatic origin (n=5). Baseline and follow-up variables included International Prostate Symptom Score (IPSS), technical success (successful bilateral prostate artery embolization), adverse events (graded by SIR classification {5}), clinical success (technical success with resolution of symptoms), catheter independence, and reintervention rates. Follow-up was performed at 1, 3, 6, and 12 months.

Results: Technical success was achieved in 32/34 patients (94.1%). In 2 patients, only unilateral prostate artery embolization was possible due to artery stenosis/calcification. Of 9 catheterized patients, 6 (66.7%) achieved catheter independence within 3 months post-PAE. Hematuria resolved in 4/5 (80%) patients. Mean IPSS improved from 26.8 ± 5.9 at baseline to 11.2 ± 4.3 at 12 months (p< 0.001). Clinical success was achieved in 28/34 (82.4%) patients.

The overall adverse event rate was 23.5% (8/34), all graded as mild AE (transient dysuria, post-embolization syndrome requiring additional medications). No major adverse events or procedure-related mortality occurred. At median follow-up of 26 months (IQR: 18-41), 3 patients (8.8%) required reintervention (2 repeat PAE, 1 TURP for recurrent LUTS). Medication discontinuation was achieved in 17/24 (70.8%) patients previously on BPH therapy.

Conclusion: In older patients with symptomatic BPH, urinary retention, or hematuria, PAE is a safe, well-tolerated, and effective alternative to surgery. It provides durable symptom relief, catheter independence in most retention patients, and a favorable safety profile, supporting its role as a front-line therapy for high-risk elderly populations.