Effectiveness and Safety of Prostatic Artery Embolization for Patients with Prostate Cancer: A Systematic Review and Meta-Analysis

Prostatic artery embolization (PAE) has received attention to manage the urological symptoms in patients with prostate cancer (PCa). This meta-analysis evaluates its effectiveness and safety in patients with PCa. A systematic review was performed by searching in PudMed and Web of Science databases for studies including either PAE or prostatic artery chemoembolization (PACE) in patients with PCa. Quantitative and qualitative analyses were performed. The primary outcomes were technical success, clinical success, oncological efficacy and adverse events (AEs). The secondary outcomes were International Prostate Symptoms Score (IPSS), quality of life (QoL), prostate volume (PV), and prostate-specific antigen (PSA). Eleven single-arm studies with 151 participants were included. The pooled technical and clinical success rates were 95.53% (95%CI: 87.23, 99.95) and 90.31% (95%CI: 73.44, 99.85), respectively, whereas the oncological efficacy was 65.89% (95%CI: 32.18, 93.13). AEs showed low rates of minor 23.88% (95%CI: 8.88, 42.39) and major 0.6% (95%CI: 0.00, 3.67). Although, PAE tended to fewer AEs compared to PACE, 20.76% vs 31.03% for minor, and 1.01% vs 0.32% for major AEs, respectively. In addition, there was a statistically significant reduction in IPSS (- 10.24, 95%CI: - 14.60,- 5.89), QoL (- 2.28, 95%CI: - 3.25, - 1.32), PV (- 22.16, 95%CI: - 34.20, - 10.13), and PSA (- 7.32, 95%CI: - 12.34, - 2.29), with greater improvements after PACE. Overall, the studies showed a high risk of bias. This meta-analysis revealed that PAE and PACE are feasible, effective, and safe techniques to control the urological symptoms in patients with PCa, and even as adyuvant treatment for local therapies.