Prostate Artery Embolization

September 3, 2024

This page was reviewed under our medical and editorial policy by Jonathan Kessler, M.D., associate clinical professor, division of interventional radiology, Department of Diagnostic Radiology, City of Hope^® Cancer Center Duarte

Prostate artery embolization (PAE) is an image-guided outpatient procedure performed by an interventional radiologist. It is primarily used to treat urinary symptoms caused by an enlarged prostate. When the prostate is too large, it may press against the urethra (the tube that carries urine out of the body) and make it difficult to urinate fully or cause frequent urination.

PAE works by blocking blood flow to the prostate. The lack of blood flow causes some of the cells to die, which helps to shrink the prostate gland. This procedure is often considered when other medical treatments have not been successful, or are not an option, for patients with prostate cancer or benign prostatic hyperplasia (BPH).

What Is Prostate Artery Embolization?

A prostate artery embolization, or PAE, is a type of transarterial embolization. It is a specialized procedure designed to help men who have lower urinary tract symptoms from a prostate gland that has grown to a bigger-than-normal size. Lower urinary tract symptoms may include a range of symptoms, such as difficulty starting urination, a weak urine stream, the need to urinate frequently (especially at night) and the feeling that the bladder is not fully empty after urinating.

PAE works by reducing the size of the prostate, which in turn alleviates these uncomfortable and sometimes disruptive symptoms. This treatment may also be used in some patients with prostate cancer to help manage their urinary symptoms.

PAE is typically considered for patients who have not found relief from medications alone.

Who Is Not a Candidate for PAE?

Prostate artery embolization is not an option for every patient. Patients should talk to their BPH care teams to evaluate whether they might be candidates for this procedure.

PAE Procedure

A PAE procedure is typically performed at a hospital or clinic on an outpatient basis, meaning patients do not need to stay overnight. Before the procedure, the patient is given a local anesthetic and light sedation to help him relax while remaining awake and comfortable. The first step in the procedure involves making a tiny incision in the groin or wrist. The radiologist inserts a thin, flexible tube called a catheter into an artery through this incision. Advanced imaging techniques help the radiologist guide the catheter through the blood vessels until it reaches the arteries that supply blood to the prostate.

Once the catheter is in the appropriate position, tiny particles are injected into the targeted arteries. These particles block blood flow to specific areas of the prostate, depriving the prostate tissue of oxygen and nutrients.

Over time, the lack of blood flow causes the prostate to shrink, which may alleviate the urinary symptoms from an enlarged prostate.

After the procedure, the catheter is removed and the incision is closed with a small bandage. Before leaving, the patient is monitored briefly to ensure there are no immediate complications and that he is able to pass urine.

Recovery

Recovery after a prostate embolization is generally smooth, with most patients experiencing only mild symptoms in the days following the procedure. Common postprocedure symptoms may include fatigue, low-grade fever, mild pelvic cramping and an increase in urinary frequency or urgency. Some patients might also notice blood in their urine or a burning sensation when urinating. These symptoms typically resolve within a few days.

Patients might be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs), a proton pump inhibitor (to prevent stomach irritation from NSAIDs) and antibiotics for about five days to manage discomfort and reduce the risk of complications. It is important to avoid strenuous activities, like heavy lifting or intense exercise, for the first few days after the procedure to prevent trauma to the puncture site.

Patients usually have follow-up appointments within the first few months to monitor progress. Most people are able to return to normal activities the next day with few precautions needed to promote recovery.

Side Effects of Prostate Artery Embolization

After a PAE, most complications are minor and tend to resolve on their own. However, it is important to be aware of the potential side effects, which may include:

• Pelvic pain or discomfort
• Frequent urination or difficulty urinating
• Blood in the urine (hematuria) or stool
• Diarrhea

These symptoms typically improve within a few days to weeks after the procedure. PAE is generally considered a safe alternative to traditional surgery. Severe complications have been rare, with the procedure showing low risk of negative impacts on erectile function or sexual health.

It may offer a shorter recovery time and fewer complications while improving urinary symptoms and quality of life for patients with BPH.

How Long Does Prostate Artery Embolization Last?

For many patients, PAE provides lasting relief from symptoms, with benefits often observed for many years following the procedure. However, some men may experience a recurrence of symptoms over time. Long-term follow-up data suggests that PAE may successfully manage symptoms, but ongoing monitoring may be necessary.