Prostatic artery embolization for palliative control of hematuria in locally advanced or metastatic prostate cancer: a systematic review.

PURPOSE: Prostatic artery embolization (PAE) has emerged as a minimally invasive option for the palliative control of hematuria in locally advanced or metastatic prostate cancer. This systematic review focuses on the efficacy and safety of PAE for this indication, while also synthesizing available data on secondary outcomes such as urinary retention and pain.

METHODS

A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science identified eight primary studies (four retrospective case series, one prospective cohort, and three case reports). Methodological quality was assessed using Joanna Briggs Institute (JBI) checklists and the Newcastle-Ottawa Scale (NOS).

RESULTS

PAE demonstrated high technical success (89-100%) and immediate hemostatic control (67-100%), with durable symptom relief in most patients. Functional improvements in urinary retention (50-80% catheter-free rates) and pain (≈ 70% improvement) were observed, though outcomes varied. Major complications were rare (< 3%), supporting PAE's safety over traditional options like TURP (higher bleeding risk) or EBRT (delayed response).

CONCLUSION

PAE offers rapid, low-risk palliation for advanced prostate cancer symptoms. While it is a valuable alternative for high-risk patients, comparative trials are needed to define its role in obstruction and pain management.