What is Prostatic Artery Embolization?

Prostatic artery embolization (PAE) is a minimally invasive treatment procedure for benign prostatic hyperplasia (BPH). During PAE, image-guided interventional radiology techniques are used to occlude the blood flow to the prostate gland by blocking the prostatic arteries. This results in a reduction of prostate size and alleviation of lower urinary tract symptoms caused by BPH.

How is PAE Performed?

Prostatic Artery Embolization is performed under local anesthesia on an outpatient basis. The interventional radiologist first identifies the prostatic arteries, which branch off the internal iliac arteries, using catheter-based angiography. A catheter is then advanced into the prostatic arteries under X-ray guidance. Small beads or particles, called embolic agents, are injected through the catheter into the arteries to occlude the blood flow. The embolic agents commonly used are polyvinyl alcohol particles or beads. The procedure takes approximately 60-90 minutes to complete.

Following the procedure, patients may experience symptoms of prostatitis such as pelvic discomfort, increased urinary frequency or urgency for a few days as the prostate tissue is dying off. Antibiotics and pain medication are usually prescribed to manage these side effects. Most patients can resume normal activities within a few days.

Benefits of PAE Over Other Treatment Options

PAE offers several advantages compared to other therapies for BPH such as medication, surgery or minimally invasive procedures:

- It is performed as a non-surgical, outpatient procedure under local anesthesia, so there is no need for hospital admission or general anesthesia. This makes the recovery faster compared to surgery.

- As no incisions are needed, the risk of surgical complications such as erectile dysfunction and incontinence associated with surgery are avoided. The risks of the procedure are also much lower than surgery.

- PAE provides immediate relief of obstruction with prostate size reduction occurring over 3-6 months as the tissue dies off. This is faster than medication where it can take months to see effects.

- Results from studies show that the improvements in urinary symptoms and flow rates with PAE are comparable or superior to other treatment options at 1-2 years of follow-up.

- It offers an alternative for patients who are poor surgical candidates, have large prostates or wish to avoid general anesthesia and surgery.

Efficacy of PAE

Several studies have evaluated the effectiveness of PAE for relieving lower urinary tract symptoms of BPH.

In a major trial of 245 patients published in The Lancet in 2016, PAE achieved significant improvements in urinary flow rates and symptom scores at 6 months as measured by the International Prostate Symptom Score (IPSS). 82% of patients had an IPSS improvement of ≥25% (defined as clinically successful) and 65% had an IPSS improvement of ≥50%. Prostate volume was also reduced by an average of 25% by 6 months compared to baseline.

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