Prostate Artery Embolisation (PAE)

1) Understanding the condition

Benign Prostatic Hyperplasia (BPH) is a non‑cancerous enlargement of the prostate gland. It is very common as men age. As the prostate enlarges, it can compress the urethra (the tube that drains urine from the bladder), leading to lower urinary tract symptoms (LUTS) such as:

• Weak or slow urine stream
• Difficulty starting urination
• Incomplete bladder emptying
• Frequent urination, urgency, or night‑time urination (nocturia)

BPH is not life‑threatening, but symptoms can significantly affect quality of life, sleep, and daily activities. The aim of treatment is symptom control and quality‑of‑life improvement, tailored to your severity of symptoms and personal priorities.

2) Treatment options

There is no single “best” treatment for everyone. Many men move through different options over time.

Conservative and medical treatments
These are usually the first step and are managed by your GP or urologist. Options include:

• Lifestyle adjustments (fluid timing, caffeine reduction)
• Medications such as alpha‑blockers or 5‑alpha reductase inhibitors

Surgical treatments
If symptoms persist or medication complications develop, surgery may be recommended. Procedures such as TURP (transurethral resection of the prostate) and other endoscopic techniques are effective but involve a hospital stay and carry risks such as bleeding, infection, urinary incontinence, and sexual side‑effects (particularly retrograde ejaculation).

Where does PAE fit?
Prostate artery embolisation sits between medical therapy and surgery. It is a minimally invasive, image‑guided treatment performed by interventional radiologists. PAE aims to improve urinary symptoms with:

• No prostate surgery
• No incision into the urinary tract
• Shorter recovery and hospital stay
• Lower risk of sexual side‑effects

Importantly, having PAE does not prevent you from having surgical treatment (such as TURP) in the future if needed.

3) What is Prostate Artery Embolisation (PAE)?

PAE is a minimally invasive procedure performed by an interventional radiologist. Using x‑ray guidance, very fine catheters are navigated into the arteries that supply blood to the prostate. Tiny medical‑grade particles or glue are injected to reduce blood flow to the enlarged prostate tissue.

By reducing its blood supply, the prostate gradually shrinks over time, relieving pressure on the urethra and improving urinary symptoms.

4) Planning and imaging

Most patients have already had investigations confirming BPH. These include an ultrasound of the prostate and bladder, urine flow studies, and blood tests including PSA. If you have not had these tests they will be organised for you.

To plan PAE safely and precisely, additional imaging may be arranged:

• CT angiogram of the pelvic arteries to map the blood supply to the prostate
• In selected cases, MRI of the prostate or further tests as advised by your urologist or radiologist

These scans act as a “road map” to guide the procedure and allow for accurate follow-up.

5) The embolisation procedure

PAE is performed in a specialised angiography suite.

• You will receive local anaesthetic at the access site and usually intravenous sedation.
• A small needle puncture is made in an artery at the wrist (radial artery) or groin (common femoral artery).
• Through this, a fine catheter and smaller micro‑catheter are guided under x‑ray to the arteries supplying the prostate.
• Tiny particles (microspheres) or medical glue is injected to reduce blood flow to the prostate.

Both sides of the prostate are usually treated through the same access point. The procedure typically takes 2–3 hours.

Afterwards, the access site is sealed and you will rest for a few hours. Most patients go home the same day; occasionally an overnight stay is recommended.

6) Preparing for your procedure

• You will need to fast from midnight before the procedure.
• Blood tests may be required to check kidney function and blood clotting.
• Some blood‑thinning medications may need to be adjusted, this will be discussed with you beforehand.
• You can usually continue your existing prostate medications.

7) Recovery (the first days to weeks)

Recovery after PAE is generally quicker than surgery.

• No driving for 24 hours after sedative medication
• Avoid heavy lifting or strenuous exercise for 48 hours
• Most patients return to normal daily activities within a few days

It is common to experience temporary worsening of urinary symptoms, mild pelvic discomfort, burning when urinating, or fatigue in the first week. These symptoms usually settle on their own.

A temporary urinary catheter is uncommon but may occasionally be required for a short period.

8) Results you can expect

Symptom improvement is gradual. Many men notice improvement within weeks to the first month. The prostate continues to shrink over 3–6 months.

Studies show that most appropriately selected patients experience meaningful improvement in urinary symptoms and quality of life.

9) What the studies show

Multiple prospective studies, randomised trials, and long-term observational series show that PAE provides meaningful and durable improvement in urinary symptoms for appropriately selected men with BPH.^1–4

• Symptom improvement: ~70–90% of patients report clinically significant improvement in LUTS and quality of life.^2–4
• Urine flow: Objective improvements in peak flow rates and post-void residual volumes are commonly observed.^2–4
• Sexual function: Erectile function is typically preserved, with a much lower risk of retrograde ejaculation compared with surgical resection.^3,4
• Safety: Major complication rates are low, and serious adverse events are uncommon when performed by experienced interventional radiologists.^1,2,4,5
• Durability: Symptom improvement is sustained in most patients at mid- and long-term follow-up; retreatment options remain available if needed.^2,4

PAE is recognised internationally as a minimally invasive treatment option that sits between medical therapy and surgery for men with bothersome BPH symptoms.^3,5,6

10) Benefits of PAE

• Minimally invasive (no prostate surgery)
• Usually day‑only procedure
• Faster recovery than surgery
• Lower risk of urinary incontinence
• Lower risk of sexual side‑effects, particularly retrograde ejaculation
• Does not prevent future surgical treatment if required

11) Risks and side‑effects

All medical procedures carry some risk. With modern techniques, serious complications from PAE are uncommon.

Common or short‑term effects:

• Temporary urinary irritation or burning
• Mild pelvic pain or discomfort
• Fatigue or low‑grade fever for a few days

Occasional risks:

• Temporary urinary retention requiring a catheter
• Urinary infection
• Bruising or bleeding at the access site

Rare but serious risks:

• Non‑target embolisation affecting nearby tissues
• Injury to blood vessels
• Kidney issues related to contrast dye (mainly in patients with existing kidney disease)

Dr Hillhouse will discuss these risks in detail and assess your individual suitability.

12) Follow‑up

• A follow‑up call is usually arranged within 1–2 weeks
• Ongoing review is tailored to your symptoms and response
• Repeat imaging may be arranged in selected cases

Close communication with your urologist and GP is maintained throughout your care.

13) Working together with your urologist

PAE is intended to complement, not replace, urological care. Patient selection, investigation, and follow-up are best managed collaboratively between your GP, urologist, and Dr Hillhouse. Many patients are referred for PAE after discussion with their urologist, particularly when symptoms persist despite medication but before committing to surgery. Importantly, PAE does not alter the anatomy of the prostate or urinary tract and does not limit future urological options, including TURP or other surgical treatments, should these be required later.

14) Frequently asked questions

Will I need a urinary catheter?
Most patients do not require a catheter after PAE. A small number of men may develop temporary urinary retention in the first few days and need a short-term catheter, usually for less than a week.

What happens to ejaculation and sexual function?
PAE has a low risk of sexual side-effects. Erections are typically unaffected. The risk of retrograde ejaculation (dry ejaculation) is significantly lower than with surgical treatments such as TURP, although no procedure can guarantee zero risk.

Does PAE treat or hide prostate cancer?
No. PAE is a treatment for benign prostate enlargement only. Appropriate assessment is performed before treatment to exclude prostate cancer. PAE does not mask prostate cancer or prevent future cancer diagnosis.

What happens to my PSA after PAE?
PSA levels may change after treatment, often decreasing as the prostate shrinks. PSA remains interpretable after PAE, and routine prostate cancer screening can continue as advised by your GP or urologist.

Can symptoms come back?
Some men may experience symptom recurrence over time. If this occurs, options include medications, repeat PAE in selected cases, or surgical treatment. Having PAE does not prevent future surgery.

15) Summary

Prostate artery embolisation is a minimally invasive treatment for benign prostate enlargement that sits between medication and surgery. For appropriately selected men, it offers meaningful symptom improvement with a shorter recovery and fewer side-effects, while preserving future treatment options.

This information is general and should always be discussed with your treating clinicians to decide what is most appropriate for you.

16) References

1. 1. Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia: state of the art. Radiology. 2013.
   2. Pisco JM et al. Prostatic arterial embolization for benign prostatic hyperplasia: long-term results in 630 patients. J Vasc Interv Radiol. 2016.
   3. Abt D et al. Prostatic artery embolization versus transurethral resection of the prostate: a prospective, randomized, open-label trial. BMJ. 2018.
   4. Ray AF et al. UK registry of prostate artery embolization: outcomes and safety. Cardiovasc Intervent Radiol. 2019.
   5. Bagla S et al. Society of Interventional Radiology position statement on prostatic artery embolization. J Vasc Interv Radiol. 2019.
   6. American Urological Association. Management of Benign Prostatic Hyperplasia (guideline statements).

Prepared for patients of Dr James Hillhouse, Interventional Radiologist.

This information is general and should be discussed with your treating clinicians.