Safety and Effectiveness of Liquid Embolics for Prostate Artery Embolization: A Systematic Review and Meta-Analysis.

PURPOSE: To systematically review the literature on the use of liquid embolics (LEs) in prostate artery embolization (PAE) and to evaluate their safety and efficacy outcomes. MATERIALS AND METHODS: A comprehensive search of PubMed, Scopus, Cochrane, and Google Scholar was performed. Studies including ≥5 patients undergoing PAE with a LEs were eligible. The outcomes included adverse events (AEs), changes in prostate volume, International Prostate Symptom Score (IPSS), and quality-of-life (QoL) at follow-up. Subgroup analyses by liquid embolic type were performed when feasible. Outcomes were pooled using a random-effects meta-analysis. RESULTS: Eleven studies (913 patients; mean/median age range, 67.5-79 years) were included. The systematic review identified that only two LEs, Ethylene-vinyl alcohol copolymer (EVOH) (n = 3 studies) and Glue (n = 8 studies), were explored in PAE. The three EVOH studies included a total of 95 cases, indicating that the current evidence base for LEs in PAE is predominantly derived from Glue experience. Of the 11 included studies, 9 were noncomparative and 2 compared LEs with particles. Pooled safety outcomes demonstrated no severe AEs. At last follow-up (range, 2-36 months), pooled mean changes from baseline were -2.73 in QoL (95% CI, -3.00 to -2.47; I2 = 76%), -31.04 mL in prostate volume (95% CI, --39.04 to -23.04; I2 = 94%), and -10.7 in IPSS (95% CI, -11.46 to -9.95; I2 = 56%). CONCLUSION: LEs, particularly glue, which constitutes the majority of the available literature appear to demonstrate promising safety and efficacy in PAE. Further prospective studies are needed to better explore the role of LEs in PAE.