What Is Prostate Artery Embolization?

Prostate artery embolization (PAE) is a minimally invasive procedure designed to address BPH urinary symptoms caused by an enlarged prostate. This treatment uses advanced imaging and interventional radiology techniques to improve symptoms in men with benign prostatic hyperplasia (BPH).

Prostate artery embolization is gaining attention because it can offer faster recovery and fewer complications compared to other BPH treatments. Patients interested in alternatives to medication or surgery may find PAE appealing for its lower risk and shorter downtime. This article will guide patients through what to expect from the procedure and how to determine if it is right for their needs.

The Prostate Artery Embolization Technique (PAE)

Prostate artery embolization uses a catheter inserted through the femoral or radial artery, typically in the groin or wrist. An interventional radiologist guides the catheter to the arteries supplying blood to the prostate.

Embolic agents, which are tiny particles, are then released, blocking the blood flow to specific areas of the prostate. This blockage causes the prostate tissue to shrink over time, resulting in symptom improvement.

Main features of PAE include:

• Performed under local anesthesia.
• No surgical incision is required.
• Recovery time is usually shorter than traditional surgery.

PAE is considered a minimally invasive alternative for patients who may not be ideal candidates for surgery.

Prostate Artery Embolization for BPH

Many men living with benign prostatic hyperplasia (BPH) experience troublesome urinary symptoms that affect their daily life, but prostate artery embolization offers a minimally invasive option to address these issues.

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that can cause lower urinary tract symptoms such as increased frequency, urgency, and weak urine stream. PAE directly targets the enlarged prostate tissue associated with BPH.

This procedure helps relieve blockage and pressure on the urethra caused by the enlarged prostate. Many patients benefit from improved urinary symptoms within weeks of the procedure.

Unlike some surgical treatments for BPH, PAE has a lower risk of sexual side effects such as erectile dysfunction or retrograde ejaculation.
PAE is particularly suitable for men wishing to avoid conventional surgery, those with higher surgical risks, or those not responding well to medications.

Prostate Artery Embolization FDA Approval

As of 2025, the FDA has not formally labeled PAE as an approved first-line treatment for BPH. The procedure, however, is performed under the supervision of board-certified interventional radiologists within the United States and other countries.

PAE is classified as an “off-label” use of embolization technology, which means it is available for use based on extensive published data and physician expertise.
Professional organizations recognize the benefits and safety profile of PAE, and insurance coverage may vary depending on provider and patient circumstances.

Patients interested in PAE should consult with specialists and discuss eligibility, risks, and alternatives, as regulatory guidance and insurance criteria can change. For specific approvals or updates, official regulatory and medical society statements should be reviewed.

Ideal Patients for Prostate Artery Embolization

How Prostate Artery Embolization Works

Prostate artery embolization (PAE) is a minimally invasive procedure targeting blood vessels that supply the prostate. It aims to relieve symptoms from benign prostatic hyperplasia by decreasing prostate size and improving urinary function.

The Procedure

PAE is performed by an interventional radiologist. They use imaging guidance to insert a catheter, typically through the femoral artery in the groin or the radial artery in the wrist. The catheter is navigated to the prostatic arteries.

Small particles are injected to block blood flow to specific areas of the prostate. This reduces the prostate’s blood supply, causing it to shrink over the following weeks. The technique is designed to avoid surgery and reduce overall risk to the patient.

A local anesthetic is given at the catheter insertion site. Patients are comfortable and awake for the procedure, which limits the need for general anesthesia or prolonged observation.

Duration of Treatment

The length of a PAE procedure usually ranges from 1 to 2 hours. The time can vary depending on the size and blood supply of the prostate, as well as the complexity of a patient’s arterial anatomy.

Pre-procedure preparation and post-procedure monitoring may add extra time. The entire visit to the treatment center often lasts half a day but can be longer if additional observation is needed.

Factors such as arterial access, individual anatomy, and any technical challenges encountered can influence the total duration. Most patients go home the same day, with only brief time spent in a recovery area.

Pre Procedure Prep

Patients undergo a thorough evaluation before the procedure, including a medical history review and prostate imaging. Blood tests may be required to check kidney function and detect any bleeding risks.

Instructions before PAE may include:

• Fasting for several hours before the procedure
• Stopping certain medications, such as blood thinners
• Arranging transportation home after discharge

Clinicians will discuss allergies, medications, and any previous reactions to contrast dyes. Following these instructions helps reduce complications and optimizes procedural safety.

Post Procedure Recovery Time

Recovery after PAE is generally rapid. Most patients are observed for a few hours after the procedure to monitor for complications such as bleeding or groin discomfort.

Patients typically return home the same day. Minor side effects may include mild pelvic pain, urinary frequency, and a low fever, which resolve within days.

Return to daily activities is often possible the next day, although strenuous exercise and heavy lifting should be avoided for about one week. Symptom relief is usually noted within several weeks as the prostate shrinks.

PAE Pre and Post Patient Instructions

Prior to the PAE Procedure:

Stop the following medications: 

Post Procedure Medication

You will be prescribed the following medications to start after your procedure to help with side effects.

• Medrole Dose Pack: Reduces prost procedure inflammation
• Prophylactic Antibiotic – This is for infection prevention
• Pyridium. This is for relief for burning with urination
• Ibuprofen (unless contraindicated) – This is for post procedure pain/inflammation
• Percocet. This is for post procedure pain relief
• Oxybutynin. This is for relief of bladder spasms (this will be prescribed on a case by case basis)

Remember to continue your regular prostate medications before and after the procedure. DOCS will NOT refill pain medications after hours: 5 pm on weekdays or anytime on the weekend. It is crucial to anticipate the need for medication refills so that they can be refilled with an adequate notification, which may take anywhere from 24 – 48 hours.

After Your Procedure

• You will be in the recovery room for about 1 hour.
• Do not drive, sign important papers, or make important decisions for the next 24 hours, as you will be using pain medications. 
• Drink plenty of fluids to prevent dehydration and to flush your kidneys. 
• For those patients who stopped Metformin, please resume 48 hours after the procedure

Activity Level

There should be no driving for 24 hours. No lifting greater than 5 pounds for 1 week. Walking and normal activities around the house are permitted.

If the vessel punctured for the procedure was in the groin:

• Minimize physical activities such as climbing stairs and excessive walking for at least 12 hours after your procedure
• Avoid frequent use of stairs for the next 24 hours

If the vessel punctured for the procedure was in the left wrist:

• Avoid lifting and excessive bending of the affected arm for 48 hours

When Can I Resume Sexual Activity 

For sexual activity, wait 1 week or once you are feeling better. If there is blood in the ejaculation, don’t be alarmed.  This is a rare side effect, but it will resolve shortly. Be sure to call our office to let us know.

Puncture Site Care

You may take the dressing off after 24 hrs and shower.  Place a band-aid over the site daily until it is healed (typically 2-3 days). It can take 5-7 days for the site to heal completely. Avoid using a jacuzzi, taking a bath or swimming until the site is healed. Keep the site clean and dry all the time. A small bruise at the puncture site can be present.

Follow-up

You will receive a follow-up call from the nurse 1 business day after your procedure.
1 month after the procedure, you will have a follow up video or phone visit with your doctor.
3 months after the procedure, you will have a follow-up visit with your doctor.

Questionnaires to reassess your symptoms will be sent to you at 1 month and 3 months after the procedure. Please complete these before your follow-up visits with your providers.

A repeat Prostate Specific Antigen test may be ordered 3 months after procedure and can be done with your urologist. 

Indications for Prostate Artery Embolization

Prostate artery embolization (PAE) is primarily used to address urinary problems related to prostate enlargement. Identifying appropriate candidates and knowing when the procedure is not suitable is essential for effective patient management.

Benign Prostatic Hyperplasia (BPH)

PAE is most commonly used to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). BPH is a noncancerous enlargement of the prostate gland that leads to symptoms such as increased urinary frequency, urgency, and weak stream.

This procedure is an alternative for patients who want to avoid traditional surgical options like TURP. PAE is especially considered for those with moderate to severe symptoms who have not responded well to medications or cannot tolerate side effects.

Relief of urinary obstruction and improvement in quality of life are the main clinical goals. PAE may also be considered for patients at higher risk from anesthesia or conventional surgery.

Eligibility Criteria

PAE eligibility is determined by several key factors:

• Presence of moderate to severe LUTS due to BPH
• Failure, intolerance, or unsatisfactory response to medical therapy
• Prostate volume typically greater than 40 grams
• Patients who prefer minimally invasive alternatives to surgery or are poor surgical candidates due to comorbidities

Candidates need to undergo detailed clinical evaluation, including medical history, assessment of symptom severity, and imaging studies such as ultrasound or MRI of the prostate. Uroflowmetry and blood tests might also be recommended to rule out other infections or causes.

Careful patient selection helps optimize outcomes and minimize the risk of complications. Multidisciplinary consultation with urologists, radiologists, and primary care providers is often involved.

Contraindications

Not every patient with BPH is a suitable candidate for PAE. Contraindications include:

• Suspected or confirmed prostate cancer
• Severe atherosclerosis or vascular disease obscuring arterial anatomy
• Active urinary tract infection
• Uncorrectable bleeding disorders
• Previous pelvic radiation or surgery that distorts pelvic vasculature

Patients with bladder stones, neurogenic bladder, or severe renal insufficiency may not benefit from PAE. Allergies to contrast agents used during the procedure should also be considered. Contraindications need thorough evaluation by an experienced medical team.

Benefits of Prostate Artery Embolization

Prostate artery embolization (PAE) offers targeted relief for men experiencing symptoms from an enlarged prostate. This treatment provides distinct advantages due to its minimally invasive approach and its ability to impact daily comfort.

Symptom Relief

PAE is effective at improving lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). These symptoms include frequent urination, sudden urges to urinate, weak urine stream, and trouble starting urination.

By blocking blood flow to specific areas of the prostate, PAE causes the prostate tissue to shrink. This reduction in size relieves pressure on the urethra. Many patients notice improvements in urinary flow and a marked decrease in nocturia after the procedure.

Clinical studies have shown that symptom severity decreases significantly within weeks of treatment. The procedure can also lower PSA levels associated with BPH, indicating a direct effect on prostate volume.

Minimally Invasive Nature

PAE is performed through a small puncture in the groin or wrist, using catheters to reach the prostate arteries. There is no need for surgical incisions or removal of tissue.

Key advantages:

• Outpatient procedure
• No requirement for general anesthesia
• Reduced hospital stay, often returning home the same day
• Lower risk of bleeding and infection compared to traditional surgery

Recovery times are usually short, with most individuals resuming normal activities within a few days. This approach also decreases postoperative pain and discomfort.

Quality of Life Improvement

Improvements in urinary symptoms translate directly to enhanced daily life. Patients experience fewer disruptions during the day and night, allowing for better sleep and mobility.

Unlike some surgical options, PAE has a low risk of sexual side effects or urinary incontinence. This supports both confidence and routine well-being following treatment.

Men who may not be candidates for surgical interventions due to other health issues often find PAE to be a suitable and well-tolerated option. As a result, many report increased satisfaction with both urinary function and overall quality of life.

Risks and Potential Side Effects

Prostate artery embolization (PAE) is generally considered safe, but some risks and side effects can occur. The likelihood and severity of these effects vary based on the patient and the experience of the medical team.

Common Side Effects of PAE

Most side effects after PAE are mild and temporary. Pelvic pain, increased urinary frequency, and mild burning with urination are frequently reported in the days following the procedure. Many patients experience some degree of blood in the urine (hematuria), semen (hematospermia), or stool, but this usually resolves within a few days.

Other short-term effects can include mild fever, fatigue, or low-grade infection. There may be localized bruising or bleeding at the catheter insertion site. Rarely, patients may have a bladder spasm or temporary difficulty urinating.

The table below summarizes some typical side effects:

Long-Term Safety Profile

Data on long-term safety suggest that serious or lasting complications from PAE are uncommon. Most adverse events are low in frequency and resolve without lasting harm. There have been rare reports of injury to pelvic blood vessels or the bladder, but these are considered unlikely when performed by experienced practitioners.

Some studies report rare instances of prolonged urinary symptoms or chronic infection, but these are not typical. The risk of permanent sexual dysfunction is very low compared to surgical options. Ongoing monitoring after the procedure helps ensure early detection of any rare complications.

Current evidence supports that PAE offers a favorable safety profile for most patients. However, those with certain underlying health conditions should discuss their individual risks with their physician.

Interventional Radiologists at Comprehensive Urology, Los Angeles

Comprehensive Urology in Los Angeles features the top interventional radiologists that Los Angeles has to offer. Our Interventional Radiologists are nationally recognized interventional radiologists offering advanced prostate artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH).  We offer a patient-centered, compassionate approach with customized care for every individual seeking treatment. Our comprehensive approach offers our patients the best outcomes at our state-of-the-art facilities in Beverly Hills.

To request an appointment for prostate artery embolization, reach out today!

Comparing Prostate Artery Embolization to Other Treatments

Prostate artery embolization (PAE) is a minimally invasive procedure designed to relieve lower urinary tract symptoms from benign prostatic hyperplasia (BPH). Patients and clinicians often compare PAE to traditional surgical procedures, newer device-based treatments, medications, and other non-surgical interventions based on effectiveness, risks, recovery time, and impact on sexual function.

Surgical Alternatives to PAE

Transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) are widely used surgical options for BPH. TURP involves removing overgrown prostate tissue through the urethra, offering consistent symptom relief but with risks like bleeding, infection, and possible sexual side effects including retrograde ejaculation. OSP is reserved for very large prostates and is more invasive, usually requiring a longer hospital stay and recovery.

Compared to surgery, PAE avoids incisions and typically has a lower risk of bleeding and infection. Studies indicate that PAE leads to fewer complications and less time in the hospital. However, surgical treatments often provide more robust and longer-lasting relief for urinary symptoms, especially for those with severe obstruction.

PAE Alternatives Comparison Chart

This chart outlines the key differences in side effects, recovery, symptom improvement, and invasiveness among common BPH treatments. PAE generally falls between medications and surgery in terms of outcomes, risks, and recovery needs.

Prostate Artery Embolization vs Urolift

UroLift is another minimally invasive therapy. It involves implanting small devices that lift and hold the prostate tissue away from the urethra, enabling better urine flow. UroLift is performed under local anesthesia with minimal downtime and does not involve tissue removal or heating.

Unlike PAE, UroLift does not use embolization or target prostate blood supply. It is associated with quick return to normal activities and a low risk of sexual dysfunction. However, UroLift tends to be most effective in men with smaller to moderate prostate sizes and may not be suitable for those with significant enlargement or median lobe obstruction.

PAE offers an option for a broader range of prostate sizes and may provide a better outcome in sexual function, particularly preserving or even improving erectile function in some cases. Both options tend to have fewer urinary side effects compared to traditional surgery.

Pharmacological Options

Medical therapy for BPH most commonly involves alpha-blockers, 5-alpha reductase inhibitors, or a combination of both. Alpha-blockers, like tamsulosin, relax smooth muscle to improve urine flow, while 5-alpha reductase inhibitors such as finasteride reduce prostate size gradually over several months.

Medications are commonly the first line of treatment due to ease of use and non-invasiveness. However, they can cause side effects including dizziness, fatigue, and sexual dysfunction such as reduced libido or ejaculation changes. Effectiveness may diminish over time, and not all patients experience sufficient symptom relief, leading some to seek procedural options like PAE.

Medications do not provide a permanent reduction in symptoms if stopped and are less likely than PAE or surgery to improve severe obstruction. They are, however, suitable for men with mild to moderate symptoms who wish to avoid procedures.

Laser and Other Minimally Invasive Procedures

Laser therapies, like Holmium Laser Enucleation of the Prostate (HoLEP) and photoselective vaporization (greenlight laser), are alternatives to traditional surgery. These procedures use high-energy lasers to remove or vaporize obstructive prostate tissue. They are minimally invasive but do require anesthesia and often a hospital stay.

Minimally invasive options also include water vapor therapy (Rezūm) and temporary implant therapies. Such procedures typically have fewer risks of bleeding, shorter catheterization times, and reduced hospital stays.

Compared with laser therapies, PAE avoids direct manipulation of the prostate and does not require general anesthesia. Both laser therapies and PAE aim for effective symptom relief with fewer side effects than older surgical options. The choice often depends on prostate size, patient health, and lifestyle preferences.

Choosing a Prostate Artery Embolization Specialist

Selecting the right specialist is important for safety and the best outcomes with prostate artery embolization (PAE). Patients should focus on specific professional qualifications and communication practices.

Qualifications to Look For

Patients should seek an interventional radiologist who is board-certified and has dedicated experience with prostate artery embolization procedures. Certification from a recognized body such as the American Board of Radiology is essential.

Extensive hands-on experience performing PAE and advanced training in vascular and interventional radiology are also crucial. Hospitals or centers where the physician practices should offer the latest imaging technology to support precise and safe embolization.

A strong record of positive patient outcomes, as documented by published case volumes and complication rates, adds another layer of assurance. It is helpful if the specialist is involved in research or continuing medical education related to benign prostatic hyperplasia (BPH) treatments.

Key Points to Verify:

• Board certification
• Years of experience with PAE
• Access to advanced equipment
• Record of patient outcomes

Questions to Ask Your Interventional Radiologist

Patients should prepare specific questions to clarify the specialist’s expertise and the details of the procedure. Inquire about the number of prostate artery embolizations performed, complication rates, and what typical recovery looks like.

Asking about pre-procedure evaluations such as whether a urinalysis, digital rectal exam, and imaging will be included demonstrates the thoroughness of the workup. Understanding the step-by-step process of PAE, including possible risks and alternatives, can help set realistic expectations.

It is useful to ask about follow-up care, including when results might be expected and how side effects are monitored or managed. Discussion of insurance coverage and logistical support is also recommended for comprehensive planning.

Recommended Questions:

• How many PAE procedures have you performed?
• What is your complication rate?
• What preoperative tests are standard in your practice?
• What post-procedure care and results can be expected?