Dr. Zorn on prostatic artery embolization for BPH

Opinion
Video

“It's 2023. We have a lot of other options. I'm not really sure that would be my frontline therapy for my dad or a family member,” says Kevin C. Zorn, MD, FRCSC, FACS.

In this video, Kevin C. Zorn, MD, FRCSC, FACS, discusses prostatic artery embolization for the treatment of benign prostatic hyperplasia. Zorn is a urologist with BPH Canada in Montreal. He was interviewed during the 2023 LUGPA Annual Meeting in Orlando, Florida.

Transcription:

Please discuss your experience with prostatic artery embolization.

I think there came an age, let's say about 5 years ago, where there was this buzz that came out of some places in South America and in Europe, where there were some radiologists who were doing these embolizations. The concept holds true. At the time, we didn't have these office-based steam therapies or iTind or UroLift. We had this dilemma where you have these really big 250-g prostates [in patients who are] on anticoagulation, but there's no one really doing HoLEP. There's only about 5% of all urologists with the skill set to do a HoLEP. So you can't do a TURP. You can't bring this person for robotic prostatectomy. So, what do we do? And there's been the RoPE trial and a few others that have looked at randomization to TURP. It does make a difference, but when you compare it to the outcomes of TURP, and now with what we see with Rezum that you can do in the office for 5 minutes under a local block or some light sedation, it kind of begs the question, why would I bring someone who can have this minimally invasive surgery or what was thought of as minimally invasive, and you're looking at some patients on the table for 2 to 3 hours...and the amount of radiation that's being exposed and the contrast, I'm not really sure that would be considered a MIST. We see in the guidelines that it can be considered, but when you really study the data and look at the outcomes of urinary flow, getting men out of retention, and the reproducibility—if I send that same patient to 3 different radiologists, do they do the same technique? That's the question. I acknowledge that it is an option. But today with the dissemination of technology, and what we have that's out there and from my clinical experience doing this for 18 years, I've probably retreated about 8 or 9 patients who did the PAE, and if anything, their prostate really didn't shrink that much and regrew, and they needed retreatment. That has to be considered. It's 2023. We have a lot of other options. I'm not really sure that would be my frontline therapy for my dad or a family member.

This transcription was edited for clarity.

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