Prostate artery embolization is a minimally-invasive procedure meant to help alleviate symptoms resulting from an enlarged prostate.
It specifically targets urinary tract symptoms resulting from benign prostatic hyperplasia (BPH) without the risk of sexual side effects.
The prostate artery embolization procedure starts with the physician puncturing an artery in the wrist or upper leg. After that, a catheter is inserted through the artery and navigated to the prostate. The primary purpose of this is to insert tiny particles into the bloodstream, thereby blocking blood flow to the prostate. In total, it usually takes 1 to 2 hours to complete the process on both sides.
By stopping the blood flow to the prostate, the prostate will shrink over time. The reduced size of the prostate relieves pressure that is causing the blockage of urine. The shrinking process takes between 2 weeks and 3 months. By the end of that period, the size of the prostate should reduce by 20-40%, depending on the severity of the initial enlargement.
What are the benefits of prostate artery embolization?
One of the best things about prostate artery embolization is that it is non-surgical and minimally-invasive. Surgery options come with a higher risk of complications, an extended recovery period, and more severe side effects. Instead, PAE patients can enjoy a less invasive safer procedure that will enable them to get back on their feet much sooner.
After getting PAE, your prostate will shrink, and your body will continue to heal itself internally over the next few months by shedding excess tissue. After the procedure, any irritation and discomfort, including excessive urinary frequency, should gradually subside.
Benign prostatic hyperplasia (BPH) can cause several sexual side effects, such as ejaculation issues and erectile dysfunction. Additionally, it may lower libido levels and result in decreased sexual function. The PAE procedure can alleviate these symptoms and has been shown to improve sexual function more effectively than surgical options.
Lastly, traditional surgical alternatives for BPH often involve the need for urinary catheterization. However, most patients who choose PAE will not need catheterization during the procedure. Many patients with severe enlargement requiring catheterization who choose to have PAE can often have the catheters removed.
Who are good candidates for the prostate artery embolization procedure?
Almost all men with enlarged prostates or symptomatic benign prostatic hyperplasia (BPH) are good candidates for prostate artery embolization.
Treatment for BPH is only considered when symptoms affect daily life. These include, but are not limited to, urinary incontinence, frequent urination, incomplete urination, or sexual side effects like erectile dysfunction or loss of libido. Recent studies have indicated that approximately 90% of men show long-term improvement in their symptoms following the procedure up to 10 years later.
Prostate artery embolization is minimally invasive and does not require surgery or drugs other than basic anti-inflammatory medication and antibiotics post-procedure. Therefore, it an excellent option for patients who have had adverse reactions to medication in the past. In addition, PAE is ideal for patients who are not good candidates for surgery due to other medical conditions.
Your interventional radiologist and urologist can determine whether you are a perfect candidate for PAE. Tests will be conducted to assess your overall health history and the size of your prostate. Your doctor can then advise you on the best way to move forward.
How does PAE differ from other BPH techniques?
Broadly speaking, there are three main ways that physicians treat BPH.
Some of the drug treatments available are alpha-blockers (Tamsulosin), which work to relax the muscles in the bladder and prostate; 5-alpha reductase inhibitors (Finasteride), which reduce the hormones responsible for prostate growth; or a combination of both. These medications are the first line of therapy in patients with symptoms from prostate enlargement. However, as with any medication, these can come with unwanted side effects, such as decreased libido.
The second line of treatment is through various surgical procedures. There are several different methods, but most involve putting a lighted scope through the urethra. The surgeon will then use various tools to relieve pressure on the bladder and increase urine flow. Prostatectomy is another procedure where the surgeon goes in through the abdomen and removes the prostate tissue. Each surgical procedure comes with different after-care and recovery times.
Prostate artery embolization is a minimally-invasive option that selectively blocks the blood flow to the prostate, thereby shrinking the prostate over time. It is a preferred option for people who do not want to have or cannot have surgery due to existing medical problems. It also is one of the procedures that best helps sexual side effects.
What is recovery like after prostate artery embolization?
Compared to other procedures that treat benign prostatic hyperplasia (BPH) symptoms, PAE has a relatively short recovery period, with milder symptoms in general. The procedure lasts approximately 1-2 hours and patients will generally be able to return home a few hours after the procedure.
After the procedure, some patients experience mild pelvic pain , slight discomfort with urination, low-grade fever or fatigue. The symptoms from the procedure usually last between 1-3 days. You should avoid strenuous activity for the first few days after the procedure. In addition, patients will be prescribed anti-inflammatory medication, painkillers, and antibiotics to decrease risk of infection.
Most patients can return to their daily activities on the following day. Your physician will also schedule a follow-up visit with you in the following weeks.
If prostate artery embolization sounds like a good fit for you, discuss this treatment option with your doctor. Before your visit, make sure to note your symptoms as well as any questions you might want to be answered.
[iv] Somwaru, A.S., Metting, S., Flisnik, L.M. et al. Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia. BMC Urol 20, 153 (2020). https://doi.org/10.1186/s12894-020-00726-y