Long-term Efficacy of Prostatic Artery Embolization Alone Versus Prostatic Artery Embolization Followed by HoLEP for Large (> 80 cm³) Benign Prostatic Hyperplasia

Rationale and objectives: To compare the long-term efficacy of prostatic artery embolization (PAE) with PAE followed by holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) in patients with large prostatic volume (PV>80 cm³), and to identify the appropriate population for PAE+HoLEP.

Methods: From March 2015 to December 2023, 208 consecutive BPH patients were enrolled into two groups: PAE monotherapy (Group A, n=168) and PAE followed by HoLEP (Group B, n=40). Differences in clinical and functional parameters between baseline and each follow-up point were compared. Cumulative clinical success rates were assessed. Predictors of lower urinary tract symptoms (LUTS) recurrence were analyzed using ROC analyses and Cox proportional hazards regression.

Results: The median follow-up times in Group A and B were 36 and 48 months. Both groups showed significant improvements in clinical and functional parameters at each follow-up period compared to baseline (P<0.01). Cumulative clinical success rates in Group A were 95.3%, 91.6%, 80.6%, 68.0%, and 47.9%, compared to 100%, 100%, 100%, 100%, and 85.7% in Group B at 1, 2, 3, 4, and 5 years. Unilateral PAE and PV≥150.3 cm³ were independent predictors of LUTS recurrence in Group A (P<0.001).

Conclusion: PAE monotherapy and combination PAE+HoLEP were effective options for patients with large PV, but the LUTS recurrence rate of PAE increased over time. Unilateral PAE was a significant factor for recurrence. Patients with PV≥150.3 cm³ could be good candidates for a combined approach.