Questions to ask before PAE

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1. Are my urinary symptoms really caused by my prostate?

   Guidelines say the workup should include a medical history, a physical exam, a urinalysis, and a symptom score called the IPSS¹. Other conditions can cause the same symptoms.

2. What is my symptom score (IPSS), and how bothered am I?

   The IPSS is a 0–35 questionnaire, and a higher score means worse symptoms³. Most PAE trials enrolled men with moderate to severe symptoms. The sham trial required a score of 20 or higher^1,4.

3. How big is my prostate, and what shape is it?

   The AUA advises checking size and shape (by ultrasound, cystoscopy, or MRI/CT) before any procedure¹. Ask how your size affects your choices. Some other procedures are limited to certain sizes, for example 30–80 g for some options¹.

4. Have I tried medicine, and what happened?

   Alpha blockers and other medicines are standard first steps¹. Most PAE trials enrolled men whose symptoms continued on medicine^4,5.

5. I have had urinary retention or use a catheter. Does that change things?

   Guidelines say surgery is recommended for retention that keeps coming back, among other problems¹. Ask how much evidence there is for PAE in your situation.

6. Will I need a CT angiogram (CTA) or other scan of my blood vessels first?

   Prostate arteries vary from person to person, and some cannot be treated safely. In the sham-controlled trial, men were excluded if CTA showed arteries not suited to PAE^1,4. Ask your team whether you need vascular imaging before treatment and what it would show.

7. How much will my symptoms improve compared with TURP?

   In a Swiss randomized trial, symptom scores improved by about 9 points after PAE and about 11 after TURP at 12 weeks. PAE did not formally prove "non-inferior," meaning not worse by more than a set margin⁶. A Spanish trial found similar symptom relief at 12 months⁷. A Cochrane review rated the evidence low certainty³.

8. Will my urine flow improve as much?

   Not usually. TURP improved flow rate, leftover urine, and prostate size more than PAE did^6,7.

9. Is PAE better than doing nothing, or than a placebo?

   In a sham-controlled trial, PAE improved symptom scores by about 13 more points than a fake procedure at 6 months⁴.

10. What side effects are common in the first week or two?

    The most common were blood in the urine (hematuria), bruising, pain in the urethra, and burning when urinating (dysuria)^1,4. Swelling in the prostate after PAE can cause a range of short-term local symptoms⁸. Ask about blood in the semen (hematospermia), which can also happen.

11. What is non-target embolization, and how do you prevent it?

    This means the tiny particles reach a nearby organ, such as the bladder, rectum, or penis, by mistake⁸. Major complications are reported as rare, about 0.3% in one review⁹. Ask how the team maps the arteries during the procedure, for example with cone-beam CT⁹.

12. How might PAE affect sex and ejaculation?

    In the trials the AUA reviewed, sexual side effects were more common with TURP. In one trial, every TURP patient had retrograde ("dry") ejaculation and no PAE patient did¹. Fewer adverse events overall were reported after PAE than after TURP^6,7. Read which BPH treatment has the fewest sexual side effects for the comparison, and ask your doctor and interventional radiologist how it applies to you.

13. How long does the benefit last, and how often do men need another procedure?

    In a large single-center series, symptom success was about 82% at 1–3 years and 76% at more than 3 years⁵. Men were more likely to need another procedure after PAE than after TURP¹. Read how well PAE works and how long it lasts and talk with your doctor.

14. What will recovery look like?

    PAE was done under local anesthesia, while TURP used spinal or general anesthesia^6,7. Ask about going home the same day, catheter use, medicines, and when to call for fever, heavy bleeding, or not being able to urinate.

15. How many PAEs have you done, and who will follow up with me?

    Ask how much PAE experience your doctor has, and how the interventional radiologist and the urologist share your care.

Sources

1. American Urological Association, BPH guideline amendment 2023, PMID 37706750 ↩︎
2. Mouli et al., JVIR 2026, PMID 42223385 ↩︎
3. Jung et al., Cochrane Database Syst Rev 2020, PMID 33368143 ↩︎
4. Pisco et al., Eur Urol 2020, PMID 31831295 ↩︎
5. Pisco et al., JVIR 2016, PMID 27321890 ↩︎
6. Abt et al., BMJ 2018, PMID 29921613 ↩︎
7. Insausti et al., JVIR 2020, PMID 32249193 ↩︎
8. Moreira et al., Cardiovasc Intervent Radiol 2017, PMID 28795212 ↩︎
9. Malling et al., Eur Radiol 2019, PMID 29948079 ↩︎