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Treatment / Prostate Artery Embolization (PAE)

Prostate Artery Embolization

Prostate artery embolization (PAE) is a treatment for BPH and a relatively new application of a long standing technology. Embolization has been performed successfully for several decades. This is a minimally invasive technique that relieves symptoms and has achieved good preliminary results.

The objective of PAE is to partially stem the blood flow supplying the prostate. PAE resolves the problem rapidly, is long lasting, and preserves the prostate. Without blood flow the abnormally enlarged prostatic tissue atrophies and symptoms improve or disappear.

Am I a Candidate for PAE?

Your interventional radiologist will work with your urologist to determine if you are a candidate for PAE. Your doctor will talk to you about your medical history and perform diagnostic testing, which may include a CT, an MRI, or an ultrasound of the prostate. You will also be asked to fill out Symptomatology, Quality-of-Life and Sexual Function surveys.

If embolization is indicated, you will need a CT angiography to evaluate the pelvic vessels and determine whether or not you are a candidate for PAE treatment.

Candidates for PAE are men who suffer from one or more of the following:

  • Sudden urge to urinate
  • Increased frequency of urination
  • Incomplete bladder emptying
  • Weakened urine streams
  • Feeling like the bladder is not completely empty after urinating
  • When severe, complete obstruction
PAE Treatment Guidelines:

  • The patient is symptomatic,
  • the patient qualifies for surgery,
  • the prostate volume is >40cc,
  • urinary flow is less than 12mL/sec and
  • there are no other contraindications.
Patients with a history of the following are not good candidates for PAE:

  • Prostate cancer
  • Neurogenic bladder
  • Advanced kidney dysfunction
  • Prostatic artery occlusion or stenosis

During the PAE Procedure

Embolization is performed under conscious sedation and involves no blood loss. Your interventional radiologist will make a small incision measuring approximately 3mm in length made in your wrist or groin through which a thin plastic tube called a catheter is introduced. The catheter is guided towards the prostatic artery using a sophisticated digital x-ray device. Once the catheter is in position, an arteriogram (an x-ray in which dye is injected into the blood vessels) is done to map the blood vessels feeding the prostate. Next, tiny particles are injected through the catheter and into the blood vessels that feed your prostate, reducing its blood supply.

Generally, the procedure takes between 1 and 2 hours. Once the embolization is completed the catheter is removed, manual compression is performed for about 10 minutes, and a small compression dressing is applied.

What Happens to the Prostate After Embolization?

Embolization results in a gradual reduction of prostate size, ranging between 10 and 50%. However, around 20% of patients experience improvement without the occurrence of any change in prostate size. Embolization is performed to improve the symptoms of BPH and not to reduce prostate volume, although this may occur in the majority of patients.

PAE Outcomes Data

In Portuguese study of 1,000 men, the reported cumulative success rate within 6 months of the procedure was 89%, which declined to 82% for the 807 patients in the 1-3 year follow-up subcohort. Patients in the “long term” post-three year category had a 78% cumulative success rate.

PAE Benefits

PAE offers many benefits compared to surgical procedures:

  • Shorter hospital stay and recovery time
  • Low risk of sexual side effects
  • Low risk of urinary incontinence
  • Shorter urinary catheterization time (may be avoided completely)
  • Decreased discomfort

Both transurethral resection of the prostate (TURP) and open prostatectomy are invasive surgeries that can result in higher rates of retrograde ejaculation (ejaculation into the bladder rather than out through the urethra), impotence, and urinary incontinence. There have been few reports of these side effects caused by PAE.

What are the risks associated with PAE?

The greatest risk comes from non-targeted embolization, the injection of particles into arteries not supplying the prostate, potentially causing severe complications. PAE is a challenging procedure that should only be performed by experienced and properly trained interventional radiologists possessing a strong understanding of pelvic vascular anatomy.

Patients may experience ‘post-PAE syndrome’ for days following the procedure, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.

Uncommon complications (10%) include blood in the urine and urinary tract infection, which is easily avoided by the prophylactic use of antibiotics prior the procedure. Very rare (2%) complications include blood in the sperm or feces.

Whether or not you are a candidate for PAE will depend on your diagnosis and a consultation with your interventional radiologist. If you suffer from BPH and are looking for treatment that can offer a safe, effective solution, prostate artery embolization may be the answer for you. Call IVC today at 503-612-0498 to schedule an appointment for a consultation. You can also read our Men’s Health Brochure.

* This information about Prostate Artery Embolization was reviewed by Dr. Jason R. Bauer. If you have any questions, please don’t hesitate to contact us using the form below.

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We are announcing that Interventional and Vascular Consultants will be closing as of March 10, 2023.

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Jason Bauer, MD RVT
Michael Pfister, MD RVT

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