Efficacy of embolic microspheres of different sizes for the treatment of benign prostatic hyperplasia: Correlation with serum prostate-specific antigen levels

Introduction: Benign prostatic hyperplasia (BPH) is a common condition in aging men that can significantly impact quality of life. Prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option. Objective: This study aimed to evaluate the clinical efficacy of super-selective PAE using microspheres of different sizes on BPH patients and investigate its correlation with serum prostate-specific antigen (PSA) expression. Methods: A prospective, single-blind randomized study was performed on 80 eligible patients treated between January 2020 and October 2022. Patients were randomly assigned to Group A (100 – 300 μm microspheres) or Group B (300 – 500 μm microspheres), with 40 patients each. Follow-ups were conducted at 1, 3, and 6 months post-embolization using ultrasound and/or computed tomography/magnetic resonance imaging, alongside PSA testing. Data collection covered prostate volume (PV), maximum urinary flow rate (Qmax), post-void residual (PVR), international prostate symptom score (IPSS), quality of life (QoL), clinical symptoms, obstruction relief, and PSA levels. Results: Significant improvements were observed in all parameters (IPSS, QoL, PV, PVR, and Qmax) at each follow-up point (all p<0.05). Group A showed superior outcomes at 6 months in both subjective (IPSS, QoL) and objective (PV, PVR, Qmax, PSA) parameters (all p<0.05). The PSA–PV correlation demonstrated a dose-response relationship. Minor complications occurred in Group A (20.0%) and Group B (12.5%), with no severe adverse events. Conclusion: PAE using 100 – 300 μm microspheres demonstrated superior outcomes and PSA reductions compared to larger particles, supporting its safety and efficacy as a treatment option for BPH.