Prostate Artery Embolization: BPH Treatment without Surgery
What is Prostate Artery Embolization?
Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate that affects roughly 50% of men in their 60s and up to 90% of men over 80. As the prostate grows, it can press on the urethra and cause frequent urination, a weak or interrupted stream, waking up multiple times at night to urinate, or a sense that the bladder never fully empties. Depending on prostate size, symptom severity, and patient preference, BPH can be treated several different ways, including medication, minimally invasive procedures, traditional surgery, or prostate artery embolization (PAE).
PAE is a nonsurgical procedure performed through a small pinhole incision in the wrist or groin, where an interventional radiologist uses live X-ray guidance to direct a microscopic catheter into the small arteries supplying the prostate. Once there, the interventional radiologist injects microscopic particles that reduce blood flow to the enlarged portions of the prostate. Over the following months, the prostate shrinks and symptoms improve, all without removing or cutting any tissue.
What are the benefits of prostate artery embolization?
PAE offers a nonsurgical option to patients who want to avoid the operating room and general anesthesia, or who are not ideal candidates for surgery. It's performed under moderate (conscious) sedation rather than general anesthesia, and most patients go home the same day. Recovery is faster than surgical options, and many men return to normal activity within a few days to a week. It is an outpatient procedure, meaning all our patients go home within two hours after the procedure.
PAE is a well-studied treatment option that is within the BPH guidelines by the American Urological Association. It achieves meaningful symptom improvement in most patients, with published studies reporting more than 50% symptom improvement alongside measurable prostate shrinkage over three to 12 months. In the smaller number of patients where PAE doesn't fully resolve symptoms, or those who turn out not to be candidates, we work directly with our urology colleagues to provide a clear path to the next appropriate treatment. Our procedure does not impact future surgery so it can act as a bridge between medical management and eventual surgery.
Who is a candidate for prostate artery embolization?
PAE is appropriate for many men with bothersome BPH symptoms who want to avoid surgery, general anesthesia, or the sexual side effects associated with some surgical options. You may be a good candidate if you have:
• Frequent urination, especially at night (nocturia).
• A weak, slow, or interrupted urinary stream.
• A sense of incomplete bladder emptying.
• Straining to urinate or a delayed start to your stream.
• An enlarged prostate confirmed by imaging or by your urologist.
• Been told you're not an ideal surgical candidate due to age, other health conditions, or blood-thinning medications.
• Significant concern about the sexual side effects of surgery and a preference for a less invasive option.
You may not be a candidate for PAE if you:
• Have a diagnosed or suspected prostate cancer that hasn't been fully worked up.
• Have an active urinary tract infection or bladder stones.
• Have significant bladder dysfunction (this is partly why urodynamic testing is sometimes needed).
• Have severe peripheral artery disease or vascular anatomy that limits safe catheter access.
• Have a serious contrast allergy or significant kidney disease.
• Have a very small prostate with a large median lobe — these cases are evaluated individually, as outcomes can be less predictable.
Because BPH can have overlapping causes, we work closely with your urologist throughout your workup. If you're referred to us directly by your urologist, they may have already completed imaging and testing we need. If you're coming to us on your own, we'll obtain a prostate MRI before your candidacy can be confirmed. Some patients may also need urodynamic testing to make sure PAE — rather than a bladder-focused issue — is the right target for treatment. The best way to know if PAE is right for you is to schedule a consultation with one of our interventional radiologists.