Ep. 387 Beyond BPH: PAE in Prostate Cancer with Dr. Nainesh Parikh

BackTable Vascular & Interventional

In this episode of BackTable, host Dr. Michael Barraza is joined by Dr. Nainesh Parikh from Moffitt Cancer Center. Dr. Parikh has worked extensively on prostate artery embolizations (PAE), having performed around 250 PAEs since joining Moffitt in 2017. The conversation delves into the multifaceted applications of PAE, with a specific focus on its role in prostate cancer.

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SHOW NOTES

Dr. Parikh outlines the various clinical scenarios where PAE proves beneficial in prostate cancer cases. This includes the potential to shrink the prostate to an optimal size for brachytherapy, decrease volume for operational convenience, and address lower urinary tract symptoms associated with enlarged prostates. Clinical improvement emerges as a major motivator, with Dr. Parikh underscored the importance of ensuring a certain volume reduction before focal therapy, thereby simplifying subsequent treatments.

The conversation extends to the role of PAE in managing radiation prostatitis, categorized clinically as chronic prostatitis. While conventional treatments often fall short for this condition, PAE emerges as an effective solution, especially for the 50% of men typically refractory to standard approaches. Dr. Parikh informs patients of the 70-75 percent chance of improvement while acknowledging the challenges in chronic prostatitis patients.

The episode explores Dr. Parikh's approach to working up patients for PAE, with most referrals originating from the GU tumor board. Dr. Parikh discusses the gland size threshold for PAE assessment, emphasizing that while larger glands generally ease embolization, he occasionally considers PAE for smaller glands based on clinical context. Challenges associated with chronic prostatitis patients are acknowledged, with a focus on managing expectations due to a lower response rate compared to other PAE patients.

Detailed insights into imaging protocols for follow-up are provided. For prostate cancer cases, Dr. Parikh recommends MRI at 6 and 12 weeks post procedure. He notes that there is notable reduction in PSA levels following PAE. Conversely, radiation prostatitis patients do not undergo post-procedural imaging unless PSA levels are detectable.

As the episode concludes, Dr. Parikh highlights the future utility of PAE in prostate cancer, particularly in neoadjuvant settings before local or radiation therapy and even post radiation therapy.