What is prostate artery embolization (PAE)?

Key facts

PAE is for bothersome urinary symptoms from BPH. It is not a cancer treatment.
PAE uses local (numbing) anesthesia. TURP surgery uses spinal or general anesthesia³.
Urinary symptoms can get worse for 3 to 7 days before they get better².
In a sham-controlled trial, symptoms improved more after PAE than after a fake procedure⁴.

How PAE works

The prostate gets blood from small arteries on each side. In PAE, the doctor puts tiny particles into those arteries to block blood flow to parts of the prostate. Without that blood supply, the prostate stops growing and begins to shrink^2,1. A growing prostate squeezes the urethra, the tube that carries urine out⁵, so a smaller prostate can ease symptoms².

Step 1. A small catheter is steered through the arteries to the prostate arteries, using X-ray pictures.
Step 2. Tiny particles go in through the catheter and slow the blood supply to parts of the prostate.
Step 3. The catheter is removed. Without that blood supply, the prostate stops growing and begins to shrink, which can ease pressure on the urethra.

How prostate artery embolization works, in three steps, seen from the front. Before treatment, the enlarged prostate squeezes the urethra and bulges up into the bottom of the bladder. Both can make it harder to pass urine and to empty the bladder fully. A simplified drawing, not to scale.

PAE is done by an interventional radiologist. The small catheter usually goes in at the wrist or the groin. Read more about interventional radiology.

Who might think about PAE

PAE may be an option for men whose urinary symptoms from BPH bother them, including men who want to avoid surgery or who care about keeping ejaculation. The workup usually includes a medical history, an exam, a urine test, and often a PSA blood test or an ultrasound⁶. Your team will tell you which scans you need before PAE.

It is a good idea to hear from both a urologist and an interventional radiologist before you choose. They can tell you which options fit the size and shape of your prostate.

What PAE is like

Before. You meet the interventional radiologist to talk about your symptoms, your tests, and your goals. Bring your questions.

During. PAE is done with numbing medicine at the skin³. Many centers also give medicine to help you relax. The doctor uses X-ray pictures to find the small arteries on each side of the prostate.

After. Most men go home the same day. Urinary symptoms can get worse for 3 to 7 days, and you may have a fever, nausea, or small amounts of blood in the urine or stool². Some men have a short group of symptoms called post-PAE syndrome⁷. Read how long PAE recovery takes.

Results

In a sham-controlled trial, symptom scores improved more after PAE than after a fake procedure⁴. A review of trials comparing PAE with TURP surgery found that symptom scores may improve about as much in the first year, though the evidence is low certainty. Men were likely to need another treatment more often after PAE⁸.

In one of those trials, urine flow improved more after TURP. Ejaculation problems were reported less often after PAE, but the difference may have been due to chance, and more than half of the men assessed after PAE still reported them³.

Risks to ask about

Like any procedure, PAE has risks. Minor side effects include frequent or difficult urination, pelvic pain, blood in the urine or stool, and diarrhea. Most go away on their own¹. Rarely, swelling makes it impossible to urinate for a while, and you may need a catheter². In one trial, fewer side effects were reported after PAE than after TURP³. Ask your doctor how often each risk happens in their practice.

PAE and your other options

Other options include watchful waiting, medicine, office procedures such as water vapor therapy (Rezum) and prostatic urethral lift (UroLift), and surgery such as TURP or laser surgery⁵. Each has its own tradeoffs for urination, recovery, and sexual function.

See BPH treatments side by side, PAE vs Rezum vs UroLift, and sexual side effects by treatment.

Questions to ask

Is my prostate a good fit for PAE, based on its size and shape?
What results should I expect for my symptoms?
How does PAE compare with TURP, Rezum, or UroLift for me?
How might PAE affect ejaculation or erections?

Common questions

Is PAE surgery?

PAE is not open surgery. It is a procedure done through a small catheter in an artery, usually at the wrist or groin, with numbing medicine. No prostate tissue is cut out.

Does PAE affect sex?

In one trial, ejaculation problems were reported less often after PAE than after TURP, but the difference may have been due to chance. No BPH treatment is free of possible sexual side effects. Ask your urologist and interventional radiologist what to expect for you.

How soon does PAE work?

After PAE, the prostate stops growing and begins to shrink, so symptoms often improve gradually. For the first 3 to 7 days, urinary symptoms can get worse before they get better.

How do I find out if PAE is right for me?

Ask your urologist about all of your options, or ask for a referral to an interventional radiologist for a PAE consult. Bring your PSA results and any prostate imaging reports.