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 randomised controlled trial of prostate embolisation vs medication for BPH

• Published in: BJU international 2024-12, Vol.134 (S2), p.38-46
• Main Authors: Brown, Nicholas, Kiosoglous, Anthony, Castree, Stephanie, Firouzmand, Sepinoud, McBean, Rhiannon, Walker, Duncan G., Wallace, Sean, Kua, Boon, Gianduzzo, Troy, Esler, Rachel C., Campbell, Peter, Schoeman, Joseph, Yaxley, John
• Format: Article
• Language: English
• Subjects: 5-alpha Reductase Inhibitors - therapeutic use; Adrenergic alpha-1 Receptor Antagonists - therapeutic use; Aged; benign prostatic hyperplasia; Clinical trials; Drug Therapy, Combination; Dutasteride - therapeutic use; Ejaculation; embolisation; Embolization; Embolization, Therapeutic - methods; Enlargement; Erectile dysfunction; Humans; Hyperplasia; Lower Urinary Tract Symptoms - drug therapy; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - therapy; Male; medical therapy; Middle Aged; Original; Patients; Prostate; Prostate - blood supply; Prostate - pathology; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - therapy; Quality of life; Tamsulosin - therapeutic use; Treatment Outcome; Urinary tract; urinary tract symptoms; urodynamics; Urological Society of Australia and New Zealand
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/bju.16479

Objective 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). Patients and Methods 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. Results The medication and PAE treatment groups had similar baseline characteristics, including prostate volumes (87.8 and 85.4 mL respectively), maximum urinary flow rate (Qmax; 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