Prostate artery embolization (PAE) provides a safe, effective, minimally invasive alternative for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). The prostate is normally a walnut-sized gland located just below the bladder with the urethra coursing through its center. In BPH, there is non-cancerous enlargement of the gland leading to encroachment of the central urethra and gradual bladder outlet obstruction. BPH has an increasing incidence with age, affecting greater than half the males over the age of 60 years. It typically manifests as urinary frequency, nocturia, urgency, hesitancy with incomplete bladder emptying, and weak stream.
Patients with BPH are initially managed conservatively with various oral medications. There are several surgical options available for patients with symptom progression and/or failure of conservative management with considerable adverse effects. In these subset of patients along with those who are not suitable surgical candidates, PAE provides a safe alternative. The safety and efficacy of PAE has been demonstrated in a recent large study and several smaller studies previously. It is now a commonly performed procedure worldwide and was endorsed by the SIR position statement on May, 2019 with the collaboration of an international panel. PAE is an outpatient procedure done through a pinhole needle incision at the wrist or the groin with minimal patient discomfort.
(1) Pisco, J et al. Medium-and-Long-term Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients. J Vasc Interv Radiol 2016; 27:1115-1122.
The RIC interventional radiologists are proficient at performing PAE with the aid of intra-procedure CT to further maximize efficacy (figure 1). Patients may experience symptom improvement as early as a few weeks after the procedure with continued improvement seen up to 6-12 months. PAE does not interfere with any concurrent or future medical or surgical interventions. Please refer to additional information at the Society of Interventional Radiology website: https://www.sirweb.org/patient-center/enlargedprostate/