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Prostate arterial chemoembolization for treatment of refractory hematuria and urinary retention in patients with localized advanced prostate cancer

Prostate Cancer and Prostatic Diseases volume 26, pages 88–95 (2023)Cite this article

Subjects

Abstract

Objectives

To evaluate the safety and efficacy transcatheter arterial chemoembolization (TACE) for the treatment of refractory gross hematuria (RGH) and urinary retention (UR) secondary to localized advanced prostate cancer (PCa).

Patients and methods

Thirty-two patients (mean age 72.5 years, range 60–89) with advanced PCa–related RGH that failed conventional therapy were included. Twenty-two of these patients had catheter-dependent due to PCa–related UR. TACE was performed with epirubicin (EPI)-eluting HepaSpheres (HS) plus intra-arterial (IA) infusion of docetaxel. Technical success, adverse events (AEs), overall survival (OS), control of RGH, removal of indwelling catheters, and local disease control, were evaluated.

Results

Technical success was achieved in 100% without major AEs. Mean follow up post-TACE was 27 months (range 8–56 months) with a mean OS of 30 months. GRH stopped within 5 days after TACE in all patients, 26 (86.7%) of these patients exhibited good bleeding control during a mean follow-up of 24 months; 17 (77.3%) of the 22 patients with UR had recovered spontaneous urination, 15 (88.2%) patients were catheter-free at their last follow-up with a mean of 24 months. BS was obtained in 73.3% (22/30) of patients at a mean follow-up of 29 months. At the last visit, 22 patients had a mean of 36 months follow-up and the mean percentage reduction in prostate volume was 55.5%, with a statistically different from baseline (P = 0.022). Negative biopsy results were obtained in 84.2% (16/19) of the patients at 12–47 months after TACE. Compared with baseline values, there was a significant improvements in IPSS, QoL, Qmax, and PVR (all P < 0.05).

Conclusions

TACE using EPI-eluting HS plus IA infusion of docetaxel is a safe and effective treatment option for the advanced PCa patients with GRH and UR, and it could be considered as an alternative if there was no other therapeutic choice.

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Fig. 1: Confirming the prostatic arterial anatomy with combined digital subtraction angiography (DSA) and cone-beam computed tomography (CB-CT). Images from a 76-year-old man with advanced prostate cancer (PCa)–related refractory gross hematuria (RGH).
Fig. 2: Multiple feeder vessels supplying the advanced PCa. Images from a 70-year-old man with advanced PCa–related RGH.
Fig. 3: Collateral supplying the recurrent prostate tumor after PAE.
Fig. 4: Complete tumor response after TACE.
Fig. 5: Complete tumor response after TACE. Images from a 69-year-old man with advanced PCa–related RGH.

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Acknowledgements

All authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. We thank Xin Ma, MD., and Xu Zhang, MD., from the Department of Urology, Chinese PLA General Hospital, for their consultations; The authors also thank Dan Feng, PhD, from the Department of Medical Statistics, Chinese PLA General Hospital, for her excellent statistical support for the manuscript. The study was supported by grants from the National Natural Science Foundation of China (82072023, 81471769) and the Central Health Research Project (W2013BJ09).

Author information

Author notes

  1. These authors contributed equally: Bing Yuan, Hainan Xin, Jin Xin Fu.

Authors and Affiliations

  1. Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China

    Mao Qiang Wang, Feng Duan, Bing Yuan, Hainan Xin & Jin Xin Fu

  2. Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, PR China

    Jin Long Zhang

  3. Department of Diagnostic Radiology, Chinese PLA General Hospital, Beijing, 100853, P. R. China

    Hui Yi Ye

  4. Department of Urology, Chinese PLA General Hospital, Beijing, 100853, P. R. China

    Hong Kai Yu

  5. Department of Oncology and Vascular Intervention, The First Hospital of Shanxi Medical University, Taiyuan, 030001, China

    Dui-Ping Feng

  6. Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, 266071, China

    Kai Cheng

  7. Department of Interventional Radiology, Tianjin Nankai Hospital, Tianjin, 300193, China

    Xiu Jun Zhang

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Contributions

Concept and design: MQW, JLZ, FD, BY, HX. Collection and assembly of data: MQW, JLZ, JXF, HYY, HKY. Data analysis and interpretation: JLZ, HYY, KC, DPF, XJZ. Initial paper writing: MQW. Critical review and final approval of paper: all authors. Accountable for all aspects of the work: MQW.

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Correspondence to Mao Qiang Wang.

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Wang, M.Q., Zhang, J.L., Duan, F. et al. Prostate arterial chemoembolization for treatment of refractory hematuria and urinary retention in patients with localized advanced prostate cancer. Prostate Cancer Prostatic Dis 26, 88–95 (2023). https://doi.org/10.1038/s41391-022-00516-7

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