Prostate Artery Embolization for BPH

Living with urinary problems can be frustrating, disruptive, and exhausting. This article explains a modern, nonsurgical option for men struggling with urinary symptoms related to prostate enlargement, including how the treatment works, who it’s for, what recovery looks like, and what results you can realistically expect.

If you’re exploring alternatives to surgery, our team at Urology of Greater Atlanta can help determine whether this approach is appropriate for you. Contact one of our practices in Georgia today to schedule a consultation and discuss your personalized care plan.

What is Prostatic Artery Embolization?

Prostate artery embolization for BPH is an image-guided treatment for benign prostatic hyperplasia, a noncancerous enlargement of the prostate gland. Also referred to as prostatic artery embolization or prostate artery embolization, the therapy is performed by interventional radiologists using advanced X-ray and CT imaging.

The goal of the PAE procedure is to block select arteries supplying the prostate. By limiting the blood supply, excess tissue begins to shrink, relieving pressure on the urethra and bladder, which improves urinary symptoms and overall urine flow. Importantly, this is done without cutting, removing tissue, or disrupting surrounding organs.

Who is a Candidate for the PAE Procedure?

Men diagnosed with benign prostatic hyperplasia (BPH) who experience lower urinary tract symptoms—such as weak stream, difficulty emptying the bladder, urgency, or frequent urination—may be candidates for this treatment.

PAE is often considered for patients who:

• Have moderate to severe BPH symptoms
• Want to avoid invasive surgical procedures or more invasive surgical procedures
• Have very large prostates
• Wish to minimize risks such as erectile dysfunction, retrograde ejaculation, or urinary incontinence

A complete review of medical history, imaging, and symptom scoring is required to determine candidacy.

Preparing for Prostatic Artery Embolization

Before PAE, patients undergo a detailed evaluation with an interventional radiologist. This includes discussing symptom severity, quality-of-life impact, and prior treatments.

The pre-procedure workup commonly includes:

• International Prostate Symptom Score (IPSS) assessment
• Measuring prostate size
• Measuring post-void residual urine in the bladder
• Imaging, such as CT or MRI, to evaluate anatomy and rule out other conditions
• PSA blood testing and urologic evaluation, including cystoscopy when indicated

The Prostatic Artery Embolization Procedure

The procedure is performed using interventional radiology techniques and does not require general anesthesia. Instead, patients receive mild IV sedation.

A small catheter inserted through either the wrist (artery access via the radial artery) or groin (through the femoral artery) allows the physician to navigate the vascular system. Using advanced imaging, a detailed roadmap of pelvic blood vessels is created.

A small catheter, approximately one millimeter wide, is guided into the prostate artery. Once positioned, tiny round microspheres or medical-grade embolic material are injected, causing targeted vessels to close within minutes. Extreme care is taken to protect arteries feeding the rectum, bladder, and penis.

Both sides of the prostate can usually be treated through a single access point. Afterward, the catheter is removed, and the puncture site is sealed.

PAE Recovery

Patients recover for a few hours and go home the same day. Bed rest is recommended for the remainder of the day to reduce bleeding risk.

During the first week, symptoms such as urgency and frequency may temporarily worsen due to inflammation as the gland begins to shrink. This typically resolves with hydration and anti-inflammatory medication. Most patients resume normal activities within one week, and improvement continues over the next several weeks. Use of a Foley catheter is uncommon.

Benefits of Prostatic Artery Embolization for Enlarged Prostate

Patients can expect a range of clinically meaningful benefits from prostate artery embolization, affecting both short-term recovery and long-term symptom control.

Short-Term Results

In the weeks following treatment, patients commonly experience the following early improvements and advantages:

• About 87.5% of patients experience significant improvement
• IPSS scores often decrease by about two-thirds, comparable to those who undergo the transurethral resection procedure (TURP)
• Minimal downtime compared with traditional surgery

Long-Term Results

Over the months after the procedure, ongoing prostate shrinkage leads to the following sustained outcomes:

• The prostate typically shrinks by about one-third over three months
• Continued symptom improvement through months two and three
• About 60% of patients stop BPH medications
• Approximately 75% of men with chronic catheters regain independent urination
• Durable relief with fewer sexual side effects than surgery

Risks and Complications of Prostate Artery Embolization

Most complications are mild. Many patients experience post-PAE syndrome, which may include nausea, fever, pelvic pain, or painful urination.

Other risks discussed by the physician include:

• Minor bleeding or hematoma at the access site
• Urinary tract infection (5–7%)
• Rare non-target embolization

Penile skin irritation occurs in about 1.5% of cases and is usually temporary. Serious complications such as urinary incontinence are exceedingly rare.

PAE and Prostate Cancer

Prostate artery embolization is not a treatment for prostate cancer. Most prostate cancers develop in the outer (peripheral) portion of the gland, which is not directly affected by embolization, as the procedure primarily targets the central obstructing tissue.

Important considerations include:

• Continued screening is essential: Patients must maintain routine prostate cancer surveillance, including regular PSA blood tests and digital rectal exams, even after PAE.
• Use in active surveillance: PAE can be safely performed in men with low-grade prostate cancer who are being actively monitored, without interfering with their surveillance plan.
• Surgical planning matters: PAE is generally not recommended for patients who are planning to undergo prostatectomy, as surgical removal of the prostate addresses urinary obstruction directly.
• Role before radiation therapy: In select cases, PAE may be beneficial before radiation therapy to reduce prostate size and help minimize urinary side effects during treatment.
• Understanding PSA changes: PSA levels often decrease after PAE due to prostate shrinkage, but this change does not indicate a reduced risk of developing prostate cancer.

What is Interventional Radiology in Urology?

Interventional Radiology allows urologic conditions to be treated through image-guided techniques rather than open surgery. Benefits include less pain, faster recovery, and lower complication rates for appropriately selected patients.

Take the Next Step Toward Lasting BPH Relief

Prostate artery embolization offers an effective, nonsurgical option for men seeking relief from BPH symptoms with a lower risk profile than surgery.

To learn whether PAE is right for you, contact our team at Urology of Greater Atlanta to schedule a consultation today. We have multiple locations in Georgia for your convenience.