Prostatic Artery Embolization Versus Medical Treatment in Symptomatic Benign Prostatic Hyperplasia

NCT ID: NCT02869971

Last Updated: 2022-05-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 90 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-08-31
• Study Completion Date: 2022-03-25

Brief Summary

The primary objective of this trial is to compare the 9-month effect on lower urinary tract symptoms (LUTS) of Prostatic Artery Embolization (PAE) using Embosphere® versus Standard Combined Therapy (alpha-blockers plus 5 alpha-reductase inhibitors) in patients with symptomatic BPH who failed after a first line medical treatment with alpha-blockers.

The secondary objectives of this study are to:

• Estimate the impact of the 2 strategies on benign prostatic hyperplasia specific Health Status (i.e. urinary and sexual signs and symptoms) at 3, 9, 18, and 24 months, as well as the side effects of the 2 strategies;
• Report the safety of PAE;
• Evaluate patient's adherence to medical treatment;
• Analyse the costs of each strategy and report the incremental efficiency (incremental cost utility ratio) of prostatic artery embolization compared to medical treatment.

Detailed Description

Benign Prostatic Hyperplasia (BPH) is the primary cause of lower urinary tract symptoms (LUTS) and affects > 50% of men >60 years. Moderate to severe symptoms prevalence is around 14% in France, and the proportion of men with moderate to severe symptoms doubles with each decade of age. The first-line treatment of bothersome BPH-related LUTS is medical therapy as recommended by French and European guidelines. 5α reductase inhibitors (5-ARI) can be combined with alpha-blockers and allow reduction of the size of the prostate and LUTS improvement. The severity of symptoms is usually assessed using the International prostate symptom score (IPSS) which is the standard questionnaire for the objective assessment of LUTS.

Recently, Prostatic Artery Embolization (PAE) has been proposed to treat symptomatic BPH with good safety and efficacy in single-centre studies (12-point IPSS reduction at 3 months maintained up to one year. In a randomized trial comparing PAE versus transurethral resection of prostate (TURP), Gao reported a 16-point IPSS reduction at 6 months, and an increase in the maximum urinary flow rate (Qmax) comprised between 12 ml/s and 24 ml/s at 6 months and up to 21 ml/s at 2 years. The complication rate is low (a few cases of bladder ulcer have been published) and the patient generally experiences mild post-embolization symptoms for few days.

PAE can be performed during a one-day hospitalisation and could be very attractive to patients which have insufficient benefit of medical treatment or who have side effects affecting their quality of life. The most used device for PAE is Embosphere® (Merit Medical). It bears the European CE (Conforme aux Exigences) marking for this specific indication and approximately 500 patients have been treated with it worldwide. Nonetheless, no big randomized study has proven its efficacy compared with best medical treatment. A study comparing PAE using Embosphere® and surgery (TURP) is currently enrolling patients; no patients could be included in France because men with BPH refused to be potentially assigned the surgical arm.

To properly evaluate PAE, the investigators designed the PARTEM trial, which has received the support of both the Societe Francaise de Radiologie (French society of radiology) and of the Association Francaise d'Urologie (French association of urology).

PARTEM will compare prospectively the benefit of PAE using Embosphere® to the benefit of combined medical treatment (Combodart®: Dutasteride 0.5mg Tamsulosin 0.4mg) at 9 months with an extended follow up at 24 months in order to evaluate the stability of results in both groups.

The investigators plan a multicentre, prospective, randomized, open label, parallel trial, comparing PAE to Combined Therapy (CT: alpha-blockers + 5-ARI treatment). Treatments will be allocated by minimization with a 1:1 ratio, based on study centre, IPSS score (moderate/severe) and prostate volume (< 80 g/≥80 g).

This study is designed to demonstrate the superiority of PAE to decrease LUTS compared to best medical treatment.

Conditions

Benign Prostatic Hyperplasia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Embolization

Prostatic Arteries Embolization

Group Type: EXPERIMENTAL

Embosphere® (Prostatic Arteries Embolization)

Intervention Type: DEVICE

Prostatic Arteries Embolization with 300-500 µm trisacryl microspheres

Combined Therapy

Combodart® : dutasteride 0.5 mg/tamsulosin 0.4 mg per day

Group Type: ACTIVE_COMPARATOR

Drug therapy

Intervention Type: DRUG

Combodart (dutasteride 0.5 mg/tamsulosin 0.4 mg)

Interventions

Embosphere® (Prostatic Arteries Embolization)

Prostatic Arteries Embolization with 300-500 µm trisacryl microspheres

Intervention Type: DEVICE

Drug therapy

Combodart (dutasteride 0.5 mg/tamsulosin 0.4 mg)

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

• Men aged>= 50 and <=85 years AND
• Moderate to severe LUTS defined as IPSS > 11, and QoL > 3 AND
• No improvement after an alpha blocker treatment line (Tamsulosin 0.4 mg p.d. during 1 month) AND
• Prostatic volume >=50 ml AND
• Affiliated to a French health insurance system

Exclusion Criteria

• Severe allergy to iodine contrast agent
• Treatment with 5-ARI on the last 6 months
• Suspected prostate cancer requiring specific management
• On-going prostatitis
• On-going urinary retention
• On-going acute urinary infection
• Acontractile detrusor
• Neurogenic lower urinary tract dysfunction
• Urethral stenosis
• Bladder diverticulum
• Bladder stone with surgical indication
• Patient refusing PAE
• Creatinine clearance <40 ml/min
• Severe liver failure
• Contra-indication to alpha-blockers
• Hypersensitivity to dutasteride, other 5-alpha reductase inhibitors, tamsulosin (including case of tamsulosin induced angioedema), soya, peanut or one of the excipients
• Hypersensitivity to gelatin or collagen
• Patients ineligible for pelvic angiography
• History of orthostatic hypotension
• Patient unable or unwilling to provide written informed consent
• Patient under legal protection

• Minimum Eligible Age: 50 Years
• Maximum Eligible Age: 85 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Ministry of Health, France

OTHER_GOV

Sponsor Role: collaborator

Assistance Publique - Hôpitaux de Paris

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Marc Sapoval, MD

Role: PRINCIPAL_INVESTIGATOR

Assistance Publique - Hôpitaux de Paris

Locations

CHU de Lyon hopital Edouard Herriot

Lyon, Auvergne-Rhône-Alpes, France

CHU de Lyon centre hospitalier Lyon Sud

Pierre-Bénite, Auvergne-Rhône-Alpes, France

CHU Rennes hopital Pontchaillou

Rennes, Brittany Region, France

CHU de Bordeaux groupe hospitalier Pellegrin

Bordeaux, Nouvelle-Aquitaine, France

CHU de Limoges

Limoges, Nouvelle-Aquitaine, France

CHU Montpellier hopital Arnaud de Villeneuve

Montpellier, Occitanie, France

CHU Montpellier hopital Lapeyronie

Montpellier, Occitanie, France

AP-HM hopital la Conception

Marseille, Provence-Alpes-Côte d'Azur Region, France

AP-HM hopital de la Timone

Marseille, Provence-Alpes-Côte d'Azur Region, France

AP-HP hopital Henri-Mondor

Créteil, Île-de-France Region, France

AP-HP - Hôpital Saint-Louis

Paris, Île-de-France Region, France

AP-HP hopital Cochin

Paris, Île-de-France Region, France

AP-HP Hopital Europeen Georges Pompidou

Paris, Île-de-France Region, France

Countries

France

References

Sapoval M, Thiounn N, Descazeaud A, Dean C, Ruffion A, Pagnoux G, Duarte RC, Robert G, Petitpierre F, Karsenty G, Vidal V, Murez T, Vernhet-Kovacsik H, de la Taille A, Kobeiter H, Mathieu R, Heautot JF, Droupy S, Frandon J, Barry Delongchamps N, Korb-Savoldelli V, Durand-Zaleski I, Pereira H, Chatellier G; PARTEM study group. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. Lancet Reg Health Eur. 2023 Jun 26;31:100672. doi: 10.1016/j.lanepe.2023.100672. eCollection 2023 Aug.

Reference Type: DERIVED

PMID: 37415648 (View on PubMed)

Other Identifiers

PHRC-15-521

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

2016-A00247-44

Identifier Type: OTHER

Identifier Source: secondary_id

P150917

Identifier Type: -

Identifier Source: org_study_id