Prostate Artery Embolisation

Prostate Artery Embolisation

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Prostate Artery Embolisation (PAE) is a minimally invasive procedure performed by Interventional Radiologists (IRs) to treat symptoms of benign prostatic hyperplasia (BPH) — a non-cancerous enlargement of the prostate gland, pioneered for this purpose in 2008 by Brazilian IR Dr Carnevale. Using advanced imaging techniques, small arteries supplying the prostate are blocked to reduce its blood flow, leading to shrinkage of the gland and improvement in urinary symptoms.
 

PAE offers a safe, non-surgical treatment option for men who wish to avoid or are unsuitable for traditional prostate surgery. 

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Who is a candidate?

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PAE may be suitable for men with:

 

• Moderate to severe urinary symptoms due to BPH

• Urinary retention 

• Enlarged prostate volume (typically >40cc though larger glands tend to respond better as compared with surgery)

• Failed, or intolerance to medical therapy

• Desire to avoid surgery or are poor surgical candidates

• Prostate-related haematuria

A detailed assessment by our Interventional Radiology team, potentially including US, MRI or CT imaging, is required to determine eligibility. Discussion with, or cross referral to Urologist (surgical specialist) may also occur for consideration of surgical treatment options.  
 

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Benefits of PAE

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• Minimally invasive with similar outcomes to invasive surgical treatments such as TURP

• No general anaesthesia required

• Same-day or next-day discharge

• No documented risk of sexual side effects

• Can be performed in patients with medical issues precluding some surgical options 

• Preserves continence and ejaculation in most men

• Durable symptom relief in most patients

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How does it work?

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Using image guidance (fluoroscopy, cone beam CT and/or CT angiography), a small catheter is inserted — usually through or femoral (groin) or radial (wrist) artery — and navigated to the prostatic arteries supplying the prostate. Tiny particles (microspheres) are then injected to block the blood flow to the prostate tissue, leading to shrinkage over time. The procedure can be performed under local anaesthesia with conscious sedation, or general anaesthesia.

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Procedure

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Before the procedure

• You will undergo a consultation with our Interventional Radiologist

• Imaging (CT/MRI), PSA levels, symptom scores, and urodynamics will be reviewed

• You may need to stop certain medications (e.g., anticoagulants, alpha blockers such as tamsulosin). The team will discuss this with you and make a plan prior to the procedure

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During the procedure

• Performed in our angiography (operating) suite under local anaesthesia and sedation, or general anaesthesia if required

• Procedure typically takes 1.5–2.5 hours

• Patients may go home the same day, or stay one night depending on procedural and practical considerations

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After the procedure

• Mild pelvic discomfort or urinary symptoms may occur for a few days. Your IR will prescribe you a medication regimen to mange these symptoms and will be available should you have concerns

• Symptom improvement is typically seen within 2–6 weeks

• A follow-up consultation with your specialist IR will be arranged

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Risks and Considerations

 

As with any medical procedure, PAE carries some risks:
 

• Bruising or bleeding at the access site 

• Urinary tract infection

• Temporary increase in urinary symptoms

• Rarely, non-target embolisation

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However, the overall complication rate is low (~0.6% significant complication risk), and the procedure is well tolerated in appropriately selected patients. ​

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Outcomes and Results

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Studies show significant symptom relief and quality-of-life improvement in most patients. Clinical trials have demonstrated:

• ~80–90% improvement in urinary symptoms at 1 year

• Sustained benefit in long-term follow-up (up to 5 years)

• Low rates of sexual or ejaculatory dysfunction

• Up to 70% of patients can become “medication free” following PAE, reducing the associated side effect profiles of these therapies

• BPH is a progressive disease. Approximately 15% of patients require another intervention or surgical procedure on their prostate within 5 years 

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Specialist Expertise

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Interventional Radiologists (IRs) are specialty trained in the care of patients undergoing prostate artery embolisation (PAE), including the pre-procedural assessment, operation and post-procedural care. Interventional Radiologists (IRs) are extensively experienced in embolisation procedures as they regularly perform embolisation in many areas of the body, including the lung, liver, spleen, kidney and pelvis.

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Multidisciplinary Care

 

It is important that you consider all main treatment options for benign prostatic hypertrophy (BPH), which includes medications and surgical options. After consultation with our interventional radiologist, your case may be discussed with or you may be referred to consult with a urologist if you haven't previously seen one.

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Preparation and Referral

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If you would like to consult with an Interventional Radiologist about prostate artery embolisation, please send a referral for consultation, including the following

 

• Imaging and blood test results

• Records of consultations with other doctors and specialists

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Public eligible patients can undergo the treatment with no out-of-pocket expense in the public system. Prostate Artery Embolisation procedures are performed at most of our public and private hospital locations in Melbourne, Victoria, Australia. 

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Prostate Artery Embolisation (PAE) content by Dr James Lisik.