CLINICAL STUDY Prostatic Artery Embolization for Treatment of Benign Prostatic Hyperplasia in Patients with Prostates > 90 g: A Prospective Single-Center Study André Moreira de Assis, MD, Airton Mota Moreira, MD, PhD, Vanessa Cristina de Paula Rodrigues, NP, Eduardo Muracca Yoshinaga, MD, Alberto Azoubel Antunes, MD, PhD, Sardis Honoria Harward, MPH, Miguel Srougi, MD, PhD, and Francisco Cesar Carnevale, MD, PhD ABSTRACT Purpose: To describe the safety and efficacy of prostatic artery embolization (PAE) with spherical microparticles to treat lower urinary tract symptoms associated with benign prostatic hyperplasia in patients with prostate volume 4 90 g. Materials and Methods: This prospective, single-center, single-arm study was conducted in 35 patients with prostate volumes ranging from 90–252 g. Mean patient age was 64.8 years (range, 53–77 y). Magnetic resonance imaging, uroflowmetry, and the International Prostate Symptom Score (IPSS) were used to assess clinical and functional outcomes. Results: Mean prostate size decreased significantly from 135.1 g before PAE to 91.9 g at 3 months of follow-up (P o .0001). Mean IPSS and quality-of-life index improved from 18.3 to 2.7 and 4.8 to 0.9 (P o .0001 for both), respectively. A significant negative correlation was observed between prostate-specific antigen at 24 hours after PAE and IPSS 3 months after PAE (P ¼ .0057). Conclusions: PAE is a safe and effective treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia in patients with prostate volume 4 90 g. Excessively elevated prostate-specific antigen within 24 hours of PAE is associated with lower symptom burden in short-term follow-up. ABBREVIATIONS BPH = benign prostatic hyperplasia, HoLEP = holmium laser enucleation of the prostate, IPSS = International Prostate Symptom Score, LUTS = lower urinary tract symptoms, OP = open prostatectomy, PAE = prostate artery embolization, PSA = prostate- specific antigen, QoL = quality of life, TURP = transurethral resection of the prostate, UR = urinary retention Benign prostatic hyperplasia (BPH) is the most common benign neoplasia in men, and moderate or severe lower urinary tract symptoms (LUTS) occur in approximately 50% of men in their 80s (1). Men with BPH can present with prostatic enlargement, bladder outlet obstruction, or both (2). LUTS secondary to BPH, such as urinary hesitancy, intermittency, urgency, and nocturia, can have a significant impact on patient quality of life (QoL) and may be relieved only partially with medical management (3). Benign prostatic hyperplasia treatment options for patients with prostates 4 90 g are limited. Transurethral resection of the prostate (TURP), considered the “gold standard” treatment for patients with smaller prostate volumes (o 90 g), is not recommended in these patients. Despite the more recent development of new techniques such as endoscopic laser enucleation, plasma enuclea- tion, and laparoscopic adenomectomy, in terms of efficacy, open prostatectomy (OP) is still considered the “gold standard” for the surgical treatment of BPH in patients with prostates 4 90 g (3–6). However, this & SIR, 2015 J Vasc Interv Radiol 2015; 26:87–93 http://dx.doi.org/10.1016/j.jvir.2014.10.012 None of the authors have identified a conflict of interest. From the Interventional Radiology and Endovascular Surgery Department (A.M.d.A., A.M.M., V.C.d.P.R., F.C.C.), Radiology Institute, and Urology Department (E.M.Y., A.A.A., M.S.), University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403000 São Paulo, Brazil; and The Dartmouth Center for Health Care Delivery Science (S.H.H.), Hanover, New Hampshire. Received February 23, 2014; final revision received October 9, 2014; accepted October 11, 2014. Address correspon- dence to A.M.d.A.; E-mail: andre.maa@gmail.com