Re: Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study

摘要

I would like to thank Dr. Kisilevzky for his comments on the recently published studies on prostatic arterial embo-lization (PAE) (1,2). I believe there are two main concerns raised. The first regards the prognostic value of magnetic resonance (MR) imaging-detected ischemia after PAE and the role of prostate volume (PV) measurements after PAE. The second questions the accuracy of PV measurements with transrectal ultrasound (US). The rationale for PAE is that prostate ischemia leads to PV reduction and hence clinical improvement. Therefore, it is logical to assume that PV reduction could be a surrogate for ischemia after PAE; both are presumably correlated. We have already shownthat PV reduction and clinical outcome do not necessarily correlate perfectly (3). This is not surprising when dealing with patients with lower urinary tract symptoms; if symptoms and PV do not correlate before any type of treatment (4), why should they after PAE? Also, many patients stop taking 5-alpha-reductase inhibitors after PAE, which is a major source of bias on the effect of PAE on PV reduction.