Analysis of Prostatic Arterial Embolization for Benign Prostatic Hyperplasia Using Embosphere Microspheres

The purpose of this study is to demonstrate the safety and efficacy of the device,
Embosphere Microspheres, in prostatic arterial embolization (PAE). PAE, is now an accepted
form of treatment for BPH outside of the United States, however few studies have been
performed demonstrating safety and efficacy in the US. Embosphere Microsphere is a device
that may be used to reduce blood flow to targeted organs. With this research, we would like
to show that Embosphere Microsphere may be used for patients with benign hyperplasia of
prostate (BPH to reduce blood flow to the prostate gland. This current study is designed to
understand the rate of improved BPH symptoms.

Patients with moderate to severe lower urinary tract symptoms resulting from BPH are
eligible for this study. Specifically, patients that have been on conservative medical
therapy for at least 6 months with no relief of symptoms are being asked to participate in
this trial. Patients meeting this criterion would traditionally be considered for more
invasive treatment options such as surgery. We believe that PAE is an acceptable alternative
to the more invasive treatment options currently the standard of care (available) and
therefore we are asking you to participate in this study. We would like to demonstrate that
PAE utilizing Embosphere Microsphere will improve their symptoms.

The gold standard of treatment for BPH is transurethral resection of the prostate (TURP). It
is very effective but is also an invasive open surgical procedure that carries a high risk
of sexual dysfunction and incontinence as side effects of the procedure. It is the goal of
this study to demonstrate that these complications are not associated with PAE and that PAE
will improve symptoms associated with BPH.

Embosphere Microspheres are small biocompatible plastic spheres that are released inside a
vessel under x-ray control. Once inside the vessel, the spheres will block the vessel and
decrease blood flow to the tissue supplied by that vessel. Embosphere Microspheres have been
cleared by the Food and Drug Administration (FDA) for use in the embolization of blood
vessels supplying uterine fibroids and vascular tumors. Additionally, they are approved in
the European Union for treatment of BPH. This study has been approved by the FDA to use
Embosphere Microspheres for research purposes in the treatment of BPH.

Inclusion Criteria:

1. Males with the clinical diagnosis of BPH.

2. IPSS >18 with symptoms that are refractory to medical treatment with combination
therapy (alpha-blocker + 5-alpha-reductase-inhibitor (5-ARI), as tolerated by the
patient) for a minimum of six months.

3. Candidates for Transurethral resection of the prostate (TURP), open prostatectomy,
Transurethral Needle Ablation (TUNA), or other procedures such as thermal ablation.

4. Patients are candidates for above procedures, however comorbid conditions present a
prohibitive surgical risk.

Exclusion Criteria:

1. Urethral strictures, bladder neck contracture, or other potentially confounding
bladder pathology.

2. Neurogenic bladder and/or sphincter abnormalities due to Parkinson's disease,
multiple sclerosis, cerebral vascular accident, diabetes, etc.

3. Uncontrolled diabetes mellitus, significant respiratory disease, or known
immunosuppression

4. Severe allergy to iodine contrast and unable to be pre-medicated.

5. Allergy to gelatin containing products.

6. Patient is on anticoagulation or anti-platelet treatment and cannot halt medication
for 5 days prior to PAE.

7. Patient is unable to have a MRI/MRA performed.

8. Magnetic Resonance Angiogram (MRA) reveals severe aorto-iliac atherosclerotic disease
prohibiting intervention.

9. Compromised renal function determined as serum creatinine level > 1.8 mg/dl, or
upper‐tract disease.

10. Prior diagnosis of any pelvic malignancy including prostate cancer.

11. Have received prior radiation to the pelvis for any condition.

12. Have had prior pelvic surgery or non-medical BPH treatment.