Prostate Artery Embolization
Benign prostatic hyperplasia (BPH) is a common non-cancerous enlargement of the prostate gland that affects a significant portion of aging men. By the age of 60, approximately 50% of men experience symptoms associated with BPH, and this number increases to 90% by the age of 85¹. BPH can lead to a range of lower urinary tract symptoms (LUTS), including
frequent urination, urgency, nocturia, weak stream, and incomplete bladder emptying. Left untreated, severe BPH can cause urinary retention, bladder stones, or kidney damage. Fortunately, multiple treatment options are available, ranging from conservative management to surgical interventions. Among these, prostate artery embolization (PAE) has emerged as a
minimally invasive alternative to traditional surgery.
Treatment Options for BPH?
Initial management for BPH often includes lifestyle modifications such as reducing fluid intake before bedtime and avoiding bladder irritants like caffeine and alcohol. If symptoms progress, medical therapy is usually the next step.
Medical Management:
- Alpha-blockers (e.g., tamsulosin) relax the muscles in the bladder neck and prostate, improving urine flow.
- 5-alpha reductase inhibitors (e.g., finasteride) shrink the prostate over time by blocking hormonal changes.
- Combination therapy can be particularly effective for larger prostates.
- Phosphodiesterase-5 inhibitors (e.g., tadalafil) are sometimes used, especially if erectile dysfunction is also a concern².
Surgical Options: When medical therapy fails or complications arise, surgical treatments are considered. The traditional gold standard is transurethral resection of the prostate (TURP). Other surgical alternatives include laser therapy, open prostatectomy, UroLift, and prostate artery embolization (PAE).
What is Prostate Artery Embolization?
Prostate artery embolization is a minimally invasive procedure performed by interventional radiologists. It involves occluding the blood vessels that supply the prostate, thereby inducing ischemia and shrinking the gland over time.³ PAE is gaining attention due to its reduced risk profile and favorable outcomes, particularly for patients who are poor candidates for surgery.
Advantage of Prostate Embolization
- Minimally invasive
- No stiches
- No internal cutting, bleeding or burning
- No general anesthesia
- No risks to testicular artery and nerve
- No risk of hydrocele
- Outpatient
- Quick recovery
How Prostate Artery Embolization is Done
The procedure begins with local anesthesia and sedation. Using fluoroscopic (X-ray) guidance, a small catheter is inserted, typically through the femoral or radial artery. Our doctor, an interventional radiologist, then navigates the catheter to the prostate arteries. Once the arteries are accessed, tiny embolic particles are injected to block blood flow, leading to ischemic necrosis and volume reduction of the prostate.³ The procedure usually takes between 1 to 2 hours and is performed on an outpatient basis, allowing most patients to return home the same day.
Success Rate of Prostate Artery Embolization
Clinical studies have shown that PAE is highly effective in relieving BPH symptoms. A large multicenter study reported that approximately 75–85% of men experienced significant improvement in urinary symptoms after PAE.⁴ Symptom relief is often seen within weeks and continues to improve over several months as the prostate shrinks. Prostate volume reductions of 20-40% are common after embolization.⁵
Moreover, PAE has shown sustained benefits, with some studies reporting symptom improvement lasting up to six years post-procedure.⁶
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Benefits of Prostate Artery Embolization Over TURP
PAE offers several advantages when compared to TURP:
- Minimally Invasive: PAE requires only a needle puncture rather than surgical cutting or resection.
- Lower Risk of Sexual Dysfunction: TURP is associated with retrograde ejaculation in up to 65% of men and erectile dysfunction in up to 10%.⁷ PAE has much lower rates of sexual side effects, preserving both ejaculation and erectile function in most cases.⁸
- Outpatient Procedure: Most PAE patients are discharged the same day, while TURP typically requires a hospital stay.
- Shorter Recovery Time: PAE recovery is usually quicker, with fewer limitations on activities compared to the more invasive TURP.
- Reduced Bleeding Risk: TURP carries a notable risk of intraoperative and postoperative bleeding, sometimes necessitating blood transfusions. PAE minimizes this risk by avoiding direct prostate resection.
Risks and Limitations of Prostate Artery Embolization
Despite its benefits, PAE is not without risks:
- Post-Embolization Syndrome: Mild pelvic pain, low-grade fever, and urinary symptoms may occur in the first few days after the procedure.
- Non-Target Embolization: There is a small risk that embolic particles could inadvertently block blood vessels supplying other organs, such as the bladder or rectum, causing unintended tissue damage.⁹
- Incomplete Symptom Relief: Some patients may not achieve sufficient symptom improvement and may still require additional therapy.
- Technical Challenges: PAE requires highly skilled interventional radiologists because of the anatomical variability of prostate arteries, making the procedure technically demanding.¹⁰
It is also worth noting that long-term head-to-head comparisons between PAE and TURP are ongoing. While short- to medium-term results are promising, TURP remains the gold standard for long-term durability and symptom relief.
Who is an Ideal Candidate for PAE?
PAE is particularly beneficial for:
- Patients with moderate-to-severe BPH symptoms.
- Patients who are poor surgical candidates due to other health issues.
- Patients seeking to preserve sexual function.
- Patients with prostates larger than 80-100 grams, where TURP becomes less effective or more dangerous.
Conversely, patients with severe bladder dysfunction or prostate cancer are typically not candidates for PAE.
Benign prostatic hyperplasia is a common condition that can significantly affect quality of life. While medications and TURP have been the traditional mainstays of treatment, prostate artery embolization offers a less invasive and lower-risk alternative for many men. With a success rate exceeding 75%, a favorable safety profile, and benefits such as reduced recovery time and preservation of sexual function, PAE is increasingly considered an attractive option for appropriate candidates. Nevertheless, thorough consultation with a urologist and interventional radiologist is essential to determine the best individualized treatment plan.
We are Here to Help
Request an Appointment to meet with our PAE specialist who will review your imaging, labs and history to determine if you are candidate for the procedure, and the outcomes you can expect. Each person is an individual and should discuss the potential risks and benefits of embolization and other treatments with our doctor to decide which option is best.
Appointments are available via an online video telehealth platform or in person at one of the offices in Los Angeles, Orange County or San Diego. Why should you choose us? Read here
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor but can act as a starting point for such a discussion.
1.) Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol. 2005;7(Suppl 9):S3–S14.
2.) Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male LUTS including benign prostatic obstruction. Eur Urol. 2013;64(1):118–140. doi:10.1016/j.eururo.2013.03.004
3.) Carnevale FC, Antunes AA. Prostatic artery embolization for benign prostatic hyperplasia: a review. Cardiovasc Intervent Radiol. 2013;36(3):594–604. doi:10.1007/s00270-012-0436-4
4.) Pisco JM, Bilhim T, Pinheiro LC, et al. Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology. 2011;259(2):621-628. doi:10.1148/radiol.11102358
5.) Bagla S, Smirniotopoulos JB, Orlando JC, et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: results from the first United States prospective trial. J Vasc Interv Radiol. 2016;27(1):8-14. doi:10.1016/j.jvir.2015.09.019
6.) Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transradial access versus transfemoral access for prostatic artery embolization: a prospective, single-center, randomized, comparative study. J Vasc Interv Radiol. 2016;27(8):1222-1229. doi:10.1016/j.jvir.2016.03.047
7.) Reich O, Gratzke C, Stief CG. Techniques and long-term results of surgical procedures for BPH. Eur Urol. 2006;49(6):970–978. doi:10.1016/j.eururo.2006.02.002
8.) Isaacson A, Fischman AM. Prostate artery embolization for benign prostatic hyperplasia: complications and how to avoid them. Cardiovasc Intervent Radiol. 2017;40(3):383-392. doi:10.1007/s00270-016-1527-7
9.) Sun F, Sánchez FM, Crisóstomo V, et al. Prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH): Part 2, Patient Selection, Technique, and Postprocedural Care. Cardiovasc Intervent Radiol. 2016;39(2):161–170. doi:10.1007/s00270-015-1237-0
10.) DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS, Gordon RL. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization in 2 patients. J Vasc Interv Radiol. 2000;11(6):767–770. doi:10.1016/s1051-0443(07)61225-1
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion.
