Prostatic Artery Embolization (PAE) is a treatment option for Benign Prostatic Hypertrophy (BPH). PAE procedures are performed by an intervention radiologist, a physician who specializes in procedures using image guidance. Under sedation, the radiologist will puncture an artery in the groin or wrist and insert a catheter toward the blood supply to the prostate. The radiologist will inject contrast dye into the vessels to guide him or her toward the location of the blood vessels of the prostate. Subsequently, the physician will release small microspheres into the blood vessels of the prostate. The goal is to decrease the blood supply to the prostate so that the prostate will shrink and relieve the bothersome urinary symptoms related to BPH.
Patients who are not interested in traditional treatment options for symptomatic BPH may be a candidate for PAE. Patients interested in PAE will need to undergo an evaluation from an Interventional Radiologist to determine if they are a candidate for PAE.
The risks associated with PAE are very different from the risks associated with traditional BPH transurethral procedures. The Interventional Radiologist will need to puncture the artery of the wrist or the groin to gain access to the arterial vascular system. There is a risk of bleeding or injury to the blood vessel associated with this method of access. Additionally, the Radiologist will need to use iodinated dye to visualize the vascular system under X-Ray guidance. The dye for some patients can cause an allergic reaction and it additionally is associated with kidney injury in some patients. There is also a phenomenon known as “Post PAE syndrome” associated with possible nausea, vomiting, fever, pain in the pelvis, and urinary frequency and burning.
PAE may result in mild improvements in the International Prostate Symptom Score (IPSS) and urinary flow rates (Qmax). These improvements seem to be better in patients with prostates larger than 40cc. The improvement in functional outcomes following PAE is diminished when compared head-to-head to traditional treatment options such as TURP or GreenLight laser.
My opinion is that patients seeking treatment for BPH should be evaluated by a physician who has training and expertise in BPH and prostate diseases. Only a urologist has such training and by getting guidance from a Radiologist who is not an expert in BPH, patients may find themselves getting treatments that they do not need, that may not be beneficial or even that could be harmful. While PAE does have its place in select situations for BPH treatment, I would opine that the treatment options offered by a urologist such as GreenLight Laser, Rezum, Urolift, and Aquablation have superior outcomes and are less risky than PAE.