Understanding Prostate Artery Embolization for BPH Treatment

By: David L. Smoger, MD

Every day, many men experience symptoms of an enlarged prostate – benign prostatic hyperplasia (BPH). An emerging treatment that serves as an alternative to surgery may reduce that number, by reducing the enlarged prostate’s lifeblood.

This procedure, called prostate artery embolization (PAE), is an incision-free option that treats the enlarged prostate, or BPH, by blocking blood flow to the prostate gland. Without blood to nourish it, the tissue shrinks.

PAE is less invasive and therefore requires less recovery time than surgery. Studies also show it is highly effective.

If you are among the millions of men who experience troubling BPH side effects, this blog will help you determine if PAE is the best treatment for you, based on your symptoms and its success rate.

BPH: Why It Happens and the Warning Signs

The prostate is a small gland that surrounds the neck of the bladder and produces the fluid that carries semen. At around the age of 25, a man’s prostate enters a growth phase that lasts his lifetime. So by the time a man turns 60, he’s 50% likely to have an enlarged prostate.

In fact, BPH is the most common prostate condition among men older than 50.

Here’s why: While the tissue growth is non-cancerous, it can in time enlarge the prostate so much that it squeezes the urethra, hindering the bladder’s ability to fully empty. This generates a range of frustrating and potentially harmful lower urinary tract symptoms. Among them:

• The sudden and frequent need to go, day and night (nocturia).
• A delay or difficulty starting to go.
• A weak, slow urine stream.
• A stream that starts and stops (and may dribble).
• The feeling that you can’t empty your bladder all the way.

If you experience these symptoms, it might be time to talk to a urologist about treatments. Depending on the severity, your doctor will likely start by recommending that you modify your diet and lifestyle, including your bathroom routine.

Prescription drugs tend to be the second course of action. These include medications that can calm the prostate and bladder muscles, or cause your prostate tissue to shrink.

After Medication, Instead of Surgery, There’s PAE

When medication fails to satisfactorily ease lower urinary tract symptoms, the traditional next step is to remove the prostate tissue. This can be achieved using electrical currents, lasers, high-pressure water therapy, or through surgery.

Prostate artery embolization, which the FDA approved in 2018, represents an alternate option for patients who do not want to or cannot undergo surgery. It achieves what tissue-shrinking drugs do, but without prescription side effects.

PAE is designed to prevent tissue growth in prostates of all sizes, yet is performed in an outpatient setting.

Here’s how PAE works:

• In an outpatient setting, you will be put under light sedation (twilight sleep).
• An interventional radiologist (IR) uses X-ray imaging to guide a narrow catheter to your prostate. The catheter is inserted through your upper leg or wrist with a small needle puncture. The catheter releases a dye into the prostate arteries to reveal which arteries feed blood to the gland.
• The IR physician then lodges microscopic beads into those arteries, blocking blood flow to the prostate. Without blood, the enlarged tissue dies and the prostate shrinks.
• Typically, the treatment takes about two hours.

After a PAE, you will require a couple of hours of bed rest and might experience temporary soreness. You should expect urinary-related symptoms to improve within three weeks.

Research Shows PAE Produces High Success Rates

Generally, men who undergo PAE can expect a success rate of 85% to 90%, with an average durability of five to seven years.

A report in the National Library of Medicine shows:

• An 85% success rate in the first year after the procedure
• 82% for up to three years
• More than 76% from three to 6.5 years

As for side effects and risks, results show PAE patients are less likely to experience ejaculation problems than other BPH procedures, according to Endovascular Today. Studies also find PAE brings a lower risk of urinary incontinence and erectile dysfunction compared with some surgeries.

Talk to Your Urologist to Learn If You’re a Candidate for PAE

Whether these benefits suit you depends on your BPH diagnosis. If you are experiencing persistent BPH symptoms, it might be time to talk to your doctor.

A urologist can determine the severity of your BPH through a physical exam and other tests to check your blood, urine, urine flow, and bladder function. (You can take the BPH Symptom Quiz here.)

If your BPH does not respond to medications and you want to avoid surgery, you could be a candidate for PAE at MidLantic Urology. Our new state-of-the-art Interventional Radiology (IR) Center is set to open in June 2025, and is where we will perform PAE.

If you have more questions about BPH, download our BPH educational booklet here. You also can learn more about PAE treatment at MidLantic on our website.