Prostate Artery Embolization (PAE) in Los Angeles

Prostate artery embolization is a minimally invasive treatment for symptomatic benign prostatic hyperplasia (BPH). PAE can help relieve lower urinary tract symptoms, including urinary incontinence, irritative voiding symptoms, increased urinary frequency, urgency, and painful urination.

The procedure is performed by a vascular and interventional radiologist, usually in collaboration with your urologist. The prostate artery embolization procedure works by embolizing (blocking) the blood vessels that supply the prostate. This is accomplished by threading a catheter to the prostate artery through a tiny puncture in your arm or in your leg using real-time imaging. Once in position, microscopic beads are injected through the catheter into the prostate artery, blocking blood flow to the prostate. Following the procedure, the prostate shrinks, relieving BPH symptoms [1].

Prostate artery embolization is used to treat symptoms of benign prostatic hyperplasia (BPH). BPH is a noncancerous condition in which the prostate gland becomes enlarged. Benign prostatic hyperplasia becomes more prevalent as men age, affecting roughly 50% of men by age 60, and roughly 80% of men older than 70 [1].

When enlarged, the prostate can obstruct the bladder and the urinary tract, causing lower urinary tract symptoms. Prostate artery embolization is only appropriate for men with symptoms of BPH. If you have urinary tract symptoms, such as frequent urination or inability to empty your bladder, then you may be a candidate for PAE. Eligibility for the PAE procedure is typically determined by urinalysis, a rectal exam, a prostate-specific antigen (PSA) test to rule out cancer, and/or an MRI or ultrasound of the prostate gland. To be considered as a candidate for PAE, typically you will need to have tried BPH medication for 6 months, and you may need to be screened for prostate cancer [1].

There are many other specialized interventions that are available for BPH, including Rezum water vapor therapy, GreenLight laser therapy, TURP resection therapy, UroLift implants, and the HoLEP procedure [2]. These therapies are beyond the scope of this article, but we encourage readers to thoroughly investigate their options before choosing a BPH treatment. Success rates, post-procedural recovery and potential side effects are particularly important to consider when comparing BPH treatments.

Patients often choose prostate artery embolization because it is less invasive than traditional surgery and less traumatic than other specialized interventions that target the prostate directly. Compared to other therapies, PAE provides minimal risk of sexual side effects, low risk of urinary incontinence, no hospital stay, quick recovery, and minimal downtime following the procedure [1].

Of the men who undergo prostate artery embolization, roughly 75%-80% report satisfactory symptom improvement. Current data indicates that prostate artery embolization lasts for 3-4 years [1], but prostate artery embolization is a relatively new procedure, and this data has been questioned for being representative of early, disparate procedure techniques [3]. Efforts have been made to optimize and standardize the procedure, which many operators believe has helped to increase its durability. Empirical data on this claim is pending.

Before the prostate artery embolization procedure, you will be given sedation and anti-anxiety medications to numb the area and help you relax. General anesthesia is typically not used for prostate artery embolization, so you will be awake during the procedure. You will be positioned flat on your back throughout, while your interventional radiologist administers the therapy.

Immediately after the prostate artery embolization procedure, you will be monitored for any complications until it is deemed safe for you to go home. Because prostate artery embolization is an outpatient procedure, you will go home on the same day as your procedure.

PAE results may not be immediate, as it takes time for the prostate to shrink. Some patients begin to experience relief within days of the procedure, but symptomatic changes are typically noticeable within 1-2 months. Symptoms continue to improve up to 6 months after the procedure.

As with any medical intervention, there are risks of prostate artery embolization like certain complications and side effects. In general, prostate artery embolization is considered to be safe and effective.

The most drastic complication of prostate artery embolization is nontarget embolization, which describes the accidental injection of particles into arteries that supply the bladder or the rectum rather than the prostate. Nontarget embolization can cause tissue necrosis and organ damage. However, readers should know that imaging technology is now used to simulate injections before the actual injection takes place, allowing operators to ensure safe injections and minimize the risk of nontarget embolization [2].

When it comes to side effects, patients may experience a brief bout of urinary retention, blood in urine, blood in semen, or blood in stool. Post-PAE syndrome is another potential side effect, which can consist of urinary urgency, urinary frequency, dysuria, pressure in the pelvis, and/or pain in the pelvis. Puncture site bleeding or infection are also possible. In the vast majority of cases, these side effects are either self limiting (they resolve on their own), or they can be treated with medications [2].