The University of Queensland, Brisbane, Queensland, Australia.
I-MED Radiology, Brisbane, Queensland, Australia.
BJU Int. 2024 Dec;134 Suppl 2(Suppl 2):38-46. doi: 10.1111/bju.16479. Epub 2024 Aug 13.
To compare prostate artery embolisation (PAE) to the combination of tamsulosin and dutasteride therapy as a potential first-line therapy for obstructive benign prostatic hyperplasia (BPH) in treatment-naïve patients in the 'Prostate Embolisation AS first-line therapY compAred to meDication in treatment naïVe men with prostAte eNlargement, a randomised ControllEd trial' (P-EASY ADVANCE).
A total of 39 men with enlarged prostates, moderate-severe lower urinary tract symptoms (LUTS) and obstructed/equivocal urodynamic studies (UDS), and who had no prior treatment for BPH, were randomised to receive either combined medical therapy with tamsulosin and dutasteride (medication) or PAE. Follow-up UDS, International Prostate Symptom Score (IPSS), uroflowmetry and ultrasound were performed at short- to medium-term intervals following interventions and compared to baseline.
The medication and PAE treatment groups had similar baseline characteristics, including prostate volumes (87.8 and 85.4 mL respectively), maximum urinary flow rate (Q; 6.5 and 6.6 mL/s, respectively), IPSS (19.5 and 21, respectively) and obstructed UDS (79% and 74%, respectively). Both interventions improved voiding and bladder outflow obstruction from baseline, with more patients unobstructed after PAE (63%) compared to medication (28%) (P = 0.03). PAE patients had significantly greater reductions in prostate size (P < 0.001), incomplete emptying (P = 0.002), total IPSS (P = 0.032), Q (P = 0.006) and quality of life (P = 0.001). Altered ejaculation, erectile dysfunction and nausea were more common in the medication group.
Prostate artery embolisation was more effective than combined medical therapy at reducing urinary obstruction, decreasing prostate volume and improving LUTS in patients with BPH who had not previously been treated. This is the first randomised control study to compare PAE and combined medical therapy in exclusively treatment-naïve patients and raises the potential of PAE as an alternative early treatment option for BPH. Further randomised comparative trials are planned to further validate the role of PAE in mitigating obstructive BPH.
在“前列腺栓塞 AS 一线治疗与药物治疗比较治疗-naïve 前列腺增大男性前列腺增生的随机对照试验”（P-EASY ADVANCE）中，比较前列腺动脉栓塞术（PAE）与坦索罗辛和度他雄胺联合治疗作为治疗初治梗阻性良性前列腺增生（BPH）的潜在一线治疗。
共纳入 39 名前列腺增大、下尿路症状（LUTS）中重度、有或无梗阻/可疑尿动力学研究（UDS）且无 BPH 既往治疗的男性患者，随机接受联合坦索罗辛和度他雄胺药物治疗或 PAE。干预后短至中期随访行 UDS、国际前列腺症状评分（IPSS）、尿流率和超声检查，并与基线比较。
药物治疗组和 PAE 治疗组基线特征相似，包括前列腺体积（分别为 87.8 和 85.4mL）、最大尿流率（Q；分别为 6.5 和 6.6mL/s）、IPSS（分别为 19.5 和 21）和梗阻性 UDS（分别为 79%和 74%）。两种干预措施均改善了排尿和膀胱流出梗阻，PAE 后无梗阻的患者比例高于药物治疗组（63% vs. 28%，P=0.03）。PAE 患者前列腺体积明显缩小（P<0.001）、不完全排空（P=0.002）、总 IPSS（P=0.032）、Q（P=0.006）和生活质量（P=0.001）明显改善。药物治疗组更常见射精改变、勃起功能障碍和恶心。
与联合药物治疗相比，PAE 能更有效地减轻未治疗的 BPH 患者的尿路梗阻、缩小前列腺体积、改善 LUTS。这是第一项比较专门治疗初治患者的 PAE 和联合药物治疗的随机对照研究，提示 PAE 可能成为 BPH 的一种替代早期治疗选择。计划进一步开展随机对照试验，以进一步验证 PAE 在缓解梗阻性 BPH 中的作用。
