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Palliative prostatic arterial embolization (PAE) in inoperable prostate cancer patients
S118
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Tuesday
4:12 PM
Scientific Session
Abstract No. 271
Prostate arterial chemoembolization for prostate cancer
TUESDAY: Scientific Sessions
J. Pisco1, T. Bilhim1, M. Ribeiro1, L. Fernandes2, N. Costa3, A. Oliveira1; 1N/A, Lisbon, Portugal; 2N/A, Lisboa, Portugal; 3Hospital Saint Louis, Lisboa, Portugal Purpose: To evaluate the safety, morbidity and preliminary results of Prostate Arterial Chemoembolization (PACE) in patients with prostate cancer. Materials: Single-center cohort prospective study, approved by the Institutional Review Board, was conducted between March 2015 to July 2016. It includes 20 patients with prostate cancer refusing other treatments due to fear or suffering of complications of their therapy. The diagnosis was confirmed by prostate biopsy. Gleason score ranged 6 to 9 and staging was T2N0M0 in all patients. Magnetic Resonance (MR), prostatic transrectal ultrasound (TRUS), digital rectal examination and prostatic specific antigen (PSA) were carried out before PACE. At baseline the following parameters were evaluated: IPSS, Qol, Qmax, IIEF, PVR and PV; and bone scintigraphy in all patients with PSA 4 10ng/mL. Pelvic computed tomographic angiography evaluated the prostatic arteries. These vessels were selectively catheterized under local anesthesia and we used Plant Mother-Tinctures (Chelidonium majus) 1.5mL, Docetaxel 1.5 ml (30mg) mixed with 1.5 ml of Embopheres 100 m to 300 m plus ultra-fluid Lipiodol 0.5 mL for the PACE. All patients were discharged 4-6 hours after the procedure and PSA was evaluated monthly for 6 months, and then every 3 months. The other parameters were evaluated at 1, 3, 6 months and every 6 months thereafter. MRI was performed at 6 months’ follow-up. Results: Twenty patients aged 57-78 years (mean age 64.7 years) underwent PACE. 4 were technical failures and 16 were technical successes. Out off the 4 technical failures, 1 was treated by brachytherapy, 2 by radical prostatectomy and 1 refused any treatment. Of the 16 technical successes, 13 (81.3%) had PSA decrease below 2mg/mL and were called ‘initial biochemical successes’. In the remaining 3 (18.7%) patients, PSA didn’t change significantly and were considered ‘initial biochemical failures’. They were treated with other therapies. PSA before PACE in cases of biochemical success ranged from 0.2ng/mL to 23.4 ng/mL (mean 7.6ng/mL) and after PACE from 0.2 ng/mL to 1.8 ng/mL (mean 0.9 ng/mL). Biochemical successes were evaluated between 6 and 18 months. In one patient PSA increase to 6.14 ng / mL at 4. There was one major complication: a bladder wall ischemia that was cured by a simple surgical intervention. 1 acute urinary retention after PACE needed an indwelling catheter for a week and another 1 reported urinary urgency for a week Conclusions: PACE for prostate cancer is a new, safe and effective outpatient procedure for prostate cancer with good preliminary results.
’
JVIR
Purpose: Palliative transurethral resection of prostate in patients with locally advanced prostate cancer is associated with greater peri-operative mortality and morbidity with a theoretical possibility of accelerating tumour growth by surgery and a documented tumour cell spread into the circulation. The purpose of our study was to evaluate the viability of superselective prostatic arterial embolization (PAE) as an alternative for symptom palliation in prostate cancer (PCa) patients who are not candidates for curative resection. Materials: An IRB approved retrospective review was performed on 9 inoperable prostate cancer patients, who underwent PAE, between Dec 2013 and September 2016. The age of patients ranged from 57 to 86 years old (mean 72 ⫾ 9 years). Indications for PAE included intractable hematuria in six patients, bladder stones and LUTS in one, pre-radiation volume reduction in another and chronic urinary retention with recurrent hematuria in the last one. Five patients were stage IV, three had stage II disease and one stage Tx. Success was defined as improvements in the following areas: symptoms, prostate specific antigen (PSA) levels, hemoglobin levels, blood transfusion requirements, and prostate or tumor size on 90 day follow-up imaging. Results: PAE was technically and clinically successful in all nine patients (100%). Complete hematuria control was achieved on average in 1.6 days (range of 0 to 4 days). One patient spontaneously voided his bladder calculi 48 hours after PAE. There were significant improvements in blood transfusion requirements, hemoglobin and PSA levels, tumor size and urinary retention. Two patients died during follow-up from underlying disease with no recurrence of hematuria. No complications were noted on follow-up. Conclusions: PAE demonstrated sufficient safety and reasonable efficacy as an alternative method for palliation of symptoms in patients with inoperable prostate cancer.
Scientific Session 29 IO: Radioembolization II Tuesday, March 7, 2017 3:00 PM – 4:30 PM Room: 151A 3:00 PM
Abstract No. 273
Comparison of fluoroscopic radiation exposure between chemoembolization and radioembolization: results from a prospective randomized study
Palliative prostatic arterial embolization (PAE) in inoperable prostate cancer patients
A. Gabr1, J. Kallini1, A. Riaz1, N. Abouchaleh1, R. Ali1, O. Uddin1, R. Lewandowski1, R. Salem2; 1Northwestern University, Chicago, IL; 2Northwestern Universityl, Chicago, IL
M. Kably1, R. Dupaix, T. Mai1, S. Bhatia1, G. Narayanan1; 1 University of Miami/ Jackson Memorial Hospital, Miami, FL
Purpose: The aim of this study is to compare radiation exposure related to fluoroscopy for patients undergoing conventional
4:21 PM
Abstract No. 272
’
Tuesday
4:12 PM
Scientific Session
Abstract No. 271
Prostate arterial chemoembolization for prostate cancer
TUESDAY: Scientific Sessions
J. Pisco1, T. Bilhim1, M. Ribeiro1, L. Fernandes2, N. Costa3, A. Oliveira1; 1N/A, Lisbon, Portugal; 2N/A, Lisboa, Portugal; 3Hospital Saint Louis, Lisboa, Portugal Purpose: To evaluate the safety, morbidity and preliminary results of Prostate Arterial Chemoembolization (PACE) in patients with prostate cancer. Materials: Single-center cohort prospective study, approved by the Institutional Review Board, was conducted between March 2015 to July 2016. It includes 20 patients with prostate cancer refusing other treatments due to fear or suffering of complications of their therapy. The diagnosis was confirmed by prostate biopsy. Gleason score ranged 6 to 9 and staging was T2N0M0 in all patients. Magnetic Resonance (MR), prostatic transrectal ultrasound (TRUS), digital rectal examination and prostatic specific antigen (PSA) were carried out before PACE. At baseline the following parameters were evaluated: IPSS, Qol, Qmax, IIEF, PVR and PV; and bone scintigraphy in all patients with PSA 4 10ng/mL. Pelvic computed tomographic angiography evaluated the prostatic arteries. These vessels were selectively catheterized under local anesthesia and we used Plant Mother-Tinctures (Chelidonium majus) 1.5mL, Docetaxel 1.5 ml (30mg) mixed with 1.5 ml of Embopheres 100 m to 300 m plus ultra-fluid Lipiodol 0.5 mL for the PACE. All patients were discharged 4-6 hours after the procedure and PSA was evaluated monthly for 6 months, and then every 3 months. The other parameters were evaluated at 1, 3, 6 months and every 6 months thereafter. MRI was performed at 6 months’ follow-up. Results: Twenty patients aged 57-78 years (mean age 64.7 years) underwent PACE. 4 were technical failures and 16 were technical successes. Out off the 4 technical failures, 1 was treated by brachytherapy, 2 by radical prostatectomy and 1 refused any treatment. Of the 16 technical successes, 13 (81.3%) had PSA decrease below 2mg/mL and were called ‘initial biochemical successes’. In the remaining 3 (18.7%) patients, PSA didn’t change significantly and were considered ‘initial biochemical failures’. They were treated with other therapies. PSA before PACE in cases of biochemical success ranged from 0.2ng/mL to 23.4 ng/mL (mean 7.6ng/mL) and after PACE from 0.2 ng/mL to 1.8 ng/mL (mean 0.9 ng/mL). Biochemical successes were evaluated between 6 and 18 months. In one patient PSA increase to 6.14 ng / mL at 4. There was one major complication: a bladder wall ischemia that was cured by a simple surgical intervention. 1 acute urinary retention after PACE needed an indwelling catheter for a week and another 1 reported urinary urgency for a week Conclusions: PACE for prostate cancer is a new, safe and effective outpatient procedure for prostate cancer with good preliminary results.
’
JVIR
Purpose: Palliative transurethral resection of prostate in patients with locally advanced prostate cancer is associated with greater peri-operative mortality and morbidity with a theoretical possibility of accelerating tumour growth by surgery and a documented tumour cell spread into the circulation. The purpose of our study was to evaluate the viability of superselective prostatic arterial embolization (PAE) as an alternative for symptom palliation in prostate cancer (PCa) patients who are not candidates for curative resection. Materials: An IRB approved retrospective review was performed on 9 inoperable prostate cancer patients, who underwent PAE, between Dec 2013 and September 2016. The age of patients ranged from 57 to 86 years old (mean 72 ⫾ 9 years). Indications for PAE included intractable hematuria in six patients, bladder stones and LUTS in one, pre-radiation volume reduction in another and chronic urinary retention with recurrent hematuria in the last one. Five patients were stage IV, three had stage II disease and one stage Tx. Success was defined as improvements in the following areas: symptoms, prostate specific antigen (PSA) levels, hemoglobin levels, blood transfusion requirements, and prostate or tumor size on 90 day follow-up imaging. Results: PAE was technically and clinically successful in all nine patients (100%). Complete hematuria control was achieved on average in 1.6 days (range of 0 to 4 days). One patient spontaneously voided his bladder calculi 48 hours after PAE. There were significant improvements in blood transfusion requirements, hemoglobin and PSA levels, tumor size and urinary retention. Two patients died during follow-up from underlying disease with no recurrence of hematuria. No complications were noted on follow-up. Conclusions: PAE demonstrated sufficient safety and reasonable efficacy as an alternative method for palliation of symptoms in patients with inoperable prostate cancer.
Scientific Session 29 IO: Radioembolization II Tuesday, March 7, 2017 3:00 PM – 4:30 PM Room: 151A 3:00 PM
Abstract No. 273
Comparison of fluoroscopic radiation exposure between chemoembolization and radioembolization: results from a prospective randomized study
Palliative prostatic arterial embolization (PAE) in inoperable prostate cancer patients
A. Gabr1, J. Kallini1, A. Riaz1, N. Abouchaleh1, R. Ali1, O. Uddin1, R. Lewandowski1, R. Salem2; 1Northwestern University, Chicago, IL; 2Northwestern Universityl, Chicago, IL
M. Kably1, R. Dupaix, T. Mai1, S. Bhatia1, G. Narayanan1; 1 University of Miami/ Jackson Memorial Hospital, Miami, FL
Purpose: The aim of this study is to compare radiation exposure related to fluoroscopy for patients undergoing conventional
4:21 PM
Abstract No. 272