Focus of the Report: The focus of this Health Technology Assessment is evaluation of the effectiveness and safety of prostatic artery embolization (PAE) compared with open prostatectomy and minimally invasive approaches to treat moderate-to-severe benign prostatic hyperplasia (BPH).

Technology Description: PAE is offered as an alternative to transurethral resection of the prostate (TURP) or open prostatectomy. PAE selectively occludes branches of the prostatic arteries and deprives the enlarged prostate of blood supply and nutrients. This leads to ischemic necrosis and shrinkage of the affected section of the prostate gland. The procedure is usually performed by an interventional radiologist with fluoroscopic guidance via a percutaneous transfemoral approach with the patient under local anesthesia and sedation. The arterial occlusion may be achieved through the placement of polyvinyl alcohol particles, coil embolizers, or microspheres.

Controversy: PAE may not be as effective as TURP due to the inability to access all branches of the prostatic artery. In addition, it requires an experienced interventional radiologist and surgical suite that provides intraoperative fluoroscopic imaging. Despite evidence that PAE might be less effective that TURP, there may be certain populations of patients who are better candidates for PAE than for TURP. However, patient selection criteria have not been established.

Key Questions:

1. Is PAE effective for reducing lower urinary tract symptoms (LUTS) associated with BPH?

2. How does PAE compare with other surgical treatments for BPH (e.g., TURP)?

3. Is PAE safe for the treatment of BPH?

4. Have definitive patient selection criteria been identified for the use of PAE to treat BPH?

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