A narrative review of the role of prostatic artery embolization in the management of post-radiation prostatitis

Abstract

Definitive radiation remains a mainstay of treatment for men who have been diagnosed with localized prostate cancer (PCa). Acute and chronic genitourinary (GU) toxicity after definitive radiotherapy (RT) can cause significant morbidity for patients. Furthermore, pinpointing the prostate and related prostatitis as the source of symptoms is very difficult and often comes down to a process of elimination. The pathophysiology underlying this prostatitis represents an even more frustrating challenge and is also poorly understood. When it has been identified as the source, radiation-induced prostatitis can be considered a form of chronic, non-bacterial prostatitis based on the NIH classification system. In this classification, radiationinduced prostatitis is exceedingly challenging to manage, with therapy focused on the three “A”s of chronic prostatitis: Anti-inflammatories, Antibiotics, and Alpha-blockers. Unfortunately, approximately 50% of men will have symptoms refractory to medical therapy with limited effectiveness of alternative medical and invasive options. Prostatic artery embolization (PAE) has been shown to be a minimally invasive, safe and clinically effective treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). While evidence for both the diagnosis and management of post-radiation prostatitis is significantly lacking, this review evaluates the novel role of PAE for the management of refractory, symptomatic radiation-induced prostatitis.