Did you know that those dealing with an enlarged prostate or Benign Prostatic Hyperplasia (BPH) may have an option to significantly improve their quality of life that doesn’t require surgery?

Prostate Artery Embolization (PAE) is a minimally invasive procedure and an effective treatment option for urinary tract issues.

Below, Dr. Alex Miller, who works at both of GBU’s Interventional Radiology Centers, answers some of the most frequently asked questions about the PAE procedure to help you understand all that you may need to know before scheduling your appointment.

As always, this information is meant to be educational and should not be taken as medical advice. Please consult with your doctor if you have any questions about your specific situation.

What is Prostate Artery Embolization (PAE)?

Dr Miller: PAE is a minimally invasive, image-guided procedure used to treat symptoms of BPH or other underlying issues that may cause an enlarged prostate, resulting in symptoms like frequent urination, difficulty or delay in starting urination, needing to wake to urinate overnight (nocturia), and feeling like you can’t fully empty your bladder. 

During the procedure, an interventional radiologist blocks specific blood vessels that supply the prostate, causing it to shrink and soften over time to relieve urinary symptoms. We’ll talk a little bit more about how this is done later on.

Who is a good candidate for PAE?

DR. MILLER: PAE may be an option for men who:

• Experience moderate to severe urinary symptoms due to BPH and/or an enlarged prostate.
• Have not found relief with medications
• Want to avoid traditional prostate surgery
• Aren't ideal candidates for surgery due to other medical conditions

A comprehensive evaluation by your urologist is required to determine if PAE is right for you.

How is the PAE procedure performed?

DR. MILLER: PAE is performed using real-time x-ray, also known as fluoroscopy. A very small catheter is inserted through an artery in the groin, and using navigable wires under fluoroscopic guidance positioned in  the arteries that supply the prostate. Very small particles (<0.2mm in size) are then injected to reduce blood flow to targeted areas of the prostate.

The procedure typically takes 60-90 minutes and patients can go home the same day. You will be lightly sedated, so you will need a ride home after the procedure is completed.

How do you prepare for a PAE procedure?

DR. MILLER: Before your appointment, we’ll walk you through the specific steps you need to take before your procedure. This can vary from person to person, especially if you are taking specific medications, such as blood thinners, insulin, or metformin.

In general, you should not eat solid food for 6 hours before your appointment, and drink only clear liquids for a few hours before the procedure. 

Is PAE painful?

DR. MILLER: Though not painful, patients can experience mild discomfort after the procedure. You’ll be prescribed several medications to take after the procedure to mitigate these side effects, and they are typically resolved by 5-7 days after the procedure. We will also prescribe pain medications for you to use if needed, though this is rarely the case.

What is the recovery time after PAE?

DR. MILLER: Recovery after a PAE procedure is fairly straightforward: you can shower the following day and resume normal activities, avoiding heavy lifting (e.g., shoveling snow, going to the gym) for 5 days.  But as always, make sure to listen to your body and give it the rest it needs.

Your care team will provide specific post-procedure instructions to support healing and symptom relief. And, of course, we’ll be here to discuss any outcomes during your follow-up appointment(s).

Are there risks or side effects associated with PAE?

DR. MILLER: As with any medical procedure, PAE carries some risks (though serious complications are uncommon).

Possible side effects may include:

• Temporary pelvic pain or discomfort
• Mild nausea or fatigue
• Urinary symptoms during the initial healing period

For patients who have experienced urinary retention previously or have a very high post-void residual (ie, have >300ml of urine in their bladder after urinating), there is a small risk of urinary retention after the procedure, about 10-15%.

Your provider will walk you through all potential risks and side effects during your consultation.

Will PAE affect sexual function or incontinence?

DR. MILLER: One of the advantages of PAE is the low risk of sexual side effects. Unlike some surgical treatments for BPH, PAE does not typically cause erectile dysfunction.

The same can be said for incontinence. You may experience some minor leaks immediately after the procedure, but this is temporary and lasts no more than a week or two. 

How effective is PAE?

DR. MILLER: Both clinical studies and patient outcomes show PAE to be effective in reducing prostate size and improving urinary symptoms for the vast majority of patients. Outcomes continue to improve over time, with long-lasting symptom relief reported by a majority of patients. For the average patient, we expect at least 50% BPH-related symptom reduction for at least 5-7 years following PAE.

If we’re not seeing the results we’re hoping for, our team is here to help you determine the next steps, whether that means another PAE procedure or another treatment option.

How do I get started?

DR. MILLER: If you’re interested in learning more about the PAE procedure, the first step is to schedule a consultation. During that appointment, your urologist will review your symptoms, medical history, and imaging studies to see if this procedure is right for you or if there’s another step to take instead.

Take the next step with Greater Boston Urology

If you have more questions about the PAE procedure or another urological issue, our team is here to help. Request an appointment at one of our convenient care centers today.