Prostatic Artery Embolisation for Refractory Haematuria in Advanced Prostate Cancer: A Case Report of PSA Normalisation

Abstract

Prostatic artery embolisation (PAE) is a well-established minimally invasive procedure for the management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. In patients with advanced prostate cancer, its primary role has been palliative, particularly for controlling refractory haematuria. However, emerging evidence suggests that PAE may offer additional cytoreductive benefits. We presented the case of an 85-year-old male with advanced prostate cancer and multiple comorbidities, including severe aortic stenosis and stage 4 chronic kidney disease, who developed refractory gross haematuria unresponsive to conservative management. Due to high surgical risk, bilateral PAE was performed via a single right femoral artery access. The procedure resulted in complete resolution of haematuria, allowing early catheter removal. Remarkably, his prostate-specific antigen (PSA) declined from 5.28 ng/mL to 0.45 ng/mL over seven months, in the absence of systemic therapy. The patient remained haematuria-free with improved voiding symptoms. This case highlights the effectiveness of PAE for haemostatic control in advanced prostate cancer and suggests potential cytoreductive effects, evidenced by sustained PSA normalisation. PAE may serve a dual role in symptom control and disease modulation in patients unsuitable for surgery or systemic therapy. Further studies are warranted to explore its oncologic impact.