Prostatic Artery Embolization

What is a prostatic artery embolization?

Prostatic artery embolization (PAE) is a minimally invasive treatment that helps improve lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). BPH is a noncancerous enlargement of the prostate gland and is the most common benign tumor found in men.

The PAE procedure is performed by an interventional radiologist (IR), a doctor who uses X-rays and other advanced imaging to see inside the body and treat conditions without surgery.

What You Need to Know

  • PAE symptoms related to benign prostatic hyperplasia are present in about one in four men by age 55, and in half of 75-year-old men.
  • Treatment is only necessary if symptoms become bothersome.
  • The PAE procedure has a lower risk of urinary incontinence and sexual side effects (retrograde ejaculation or erectile dysfunction), when compared with more invasive surgical procedures such as a transurethral resection of the prostate (TURP).

What is Prostate Artery Embolization

Why have prostatic artery embolization?

As the prostate gets bigger, it may constrict or partly block the urethra, causing lower urinary tract symptoms such as:

  • Urinary incontinence, which can range from some leaking to complete loss of bladder control
  • Irritative voiding symptoms
  • Increased urinary frequency, urgency and pain upon urination

For some patients, these symptoms interfere with their quality of life.

How do I know if prostatic artery embolization is right for me?

The PAE procedure is for candidates who are either ineligible or not interested in traditional surgery. An exam with an interventional radiologist can determine if you are a candidate for PAE. At this appointment, you may be asked how often you have urinary symptoms of BPH, how severe they are, and how much they affect your quality of life.

Pre-procedure workup may include:

  • Urine test (urinalysis)
  • Digital rectal exam to help assess the size of your prostate
  • In some cases, a prostate-specific antigen (PSA) test is done to help rule out prostate cancer.
  • An MRI or ultrasound of the prostate gland

What happens during prostatic artery embolization?

  • PAE is performed by an interventional radiologist (IR). An interventional radiologist is a doctor who uses X-rays and other imaging techniques to see inside the body and treat conditions without surgery.
  • A Foley catheter (a thin, hollow tube held in place with a balloon at the end) may be inserted into your urethra and positioned in your bladder to provide a reference point for the surrounding anatomy.
  • PAE is performed through a small catheter inserted by your interventional radiologist into the artery in your wrist or groin. The interventional radiologist will then guide the catheter into the vessels that supply blood to your prostate.
  • An arteriogram (an X-ray in which dye is injected into the blood vessels) is done to map the blood vessels feeding your prostate.
  • Tiny round microspheres (particles) are injected through the catheter and into the blood vessels that feed your prostate to reduce its blood supply.
  • The interventional radiologist will move the catheter in order to treat the other side of your prostate, repeating the steps above.
  • Following this procedure, the prostate will begin to shrink, relieving and improving symptoms, usually within days of the procedure.

Our Approach to PAE

man talking to doctor

Johns Hopkins board-certified interventional radiologists diagnose and treat complex conditions with less risk, less pain and less recovery time, compared to open surgery and with unprecedented precision.

What are the risks of prostatic artery embolization?

PAE should only be performed by knowledgeable and trained interventional radiologists. Patients may experience “post-PAE syndrome” for days following the procedure, which can include nausea, vomiting, fever, pelvic pain, or painful or frequent urination.

Other risks include hematoma at the incision site; blood in the urine, semen or stool; bladder spasm; or infection of the puncture site or prostate.

Next Steps

Here are some tips to help you get the most from a visit to your interventional radiologist:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of treatments or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time and purpose for that visit.
  • Know how you can contact your provider if you have questions.