Prostate artery embolisation (PAE) is a minimally invasive interventional radiology procedure that has gained increasing attention as a promising treatment option for benign prostatic hyperplasia (BPH), a common condition affecting aging men.
BPH, characterised by the non-malignant enlargement of the prostate gland, often leads to bothersome lower urinary tract symptoms (LUTS) and can significantly impact quality of life. PAE offers an alternative to traditional surgical interventions such as transurethral resection of the prostate (TURP), HoLEP, Urolift or (in severe cases) prostatectomy, providing symptomatic relief while avoiding some of the potential risks and complications associated with surgery.
PAE involves the selective catheterisation and embolisation of the prostatic arteries, which are responsible for supplying blood to the prostate gland. By occluding these arteries with embolic agents, PAE aims to induce ischemic necrosis and subsequent shrinkage of the prostate gland, thereby alleviating urinary symptoms.
The procedure is typically performed by an interventional radiologist under local anaesthesia and conscious sedation, with guidance from fluoroscopy and angiography.
PAE is minimally invasive, typically performed as an outpatient procedure, and patients can often return to their normal activities within a few days. Additionally, PAE preserves sexual function and urinary continence, making it an attractive option for men concerned about the potential side effects of surgery.
Clinical studies evaluating the efficacy and safety of PAE have demonstrated promising results in relieving LUTS associated with BPH. Several randomised controlled trials and prospective cohort studies have reported significant improvements in International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and quality of life following PAE.
These improvements are sustained over long-term follow-up, with many patients experiencing durable symptomatic relief for up to five years or more. Additionally, PAE can be safely repeated if necessary, offering a potential alternative for patients who experience recurrence of symptoms following initial treatment.
While PAE has demonstrated efficacy in improving urinary symptoms and quality of life, patient selection remains crucial for optimising outcomes. Ideal candidates for PAE are typically men with moderate to severe LUTS secondary to BPH who have failed conservative management or are not candidates for surgery.
Moreover, PAE has been shown to be effective in treating large prostates and patients with severe urinary symptoms who may not be suitable candidates for surgery. Unlike surgical interventions, PAE does not involve a general anaesthetic, making it particularly well-suited for men with significant comorbidities.
Men with BPH and also on anticoagulation can undergo a PAE without ceasing their blood thinners, and the potential bleeding complications associated with anticoagulation and surgery are also avoided.
Pre-procedural evaluation, including urological assessment, prostate imaging, and prostate-specific antigen (PSA) testing, helps identify suitable candidates and ensure that PAE is performed safely and effectively. As with any medical procedure, PAE carries certain risks and potential complications, including urinary retention, urinary tract infection, and post-embolisation syndrome (flu-like symptoms).
However, serious adverse events are rare, and the overall safety profile of PAE is favourable compared to surgical interventions. Close monitoring and follow-up care are essential to identify and manage any potential complications promptly.
Prostate artery embolization represents a promising minimally invasive treatment option for men with benign prostatic hyperplasia and bothersome lower urinary tract symptoms.
With its proven efficacy, safety, and minimal impact on sexual function, PAE offers a valuable alternative to traditional surgical interventions. Continued research and clinical experience will further refine patient selection criteria, optimise procedural techniques, and expand the role of PAE in the management of BPH, ultimately improving outcomes for men seeking relief from urinary symptoms.
Key messages
- Prostate artery embolisation is a minimally invasive endovascular option for treatment of LUTS and BPH
- It is effective especially in non-candidates for surgical interventions, but also in men wanting to avoid TURP or other transurethral procedures
- It is an awake day-case procedure, with preservation of sexual function and urinary continence.
Author competing interests – nil