Guide to Prostate Artery Embolisation
Explore our guide to Prostate Artery Embolisation, a minimally invasive treatment for enlarged prostate. Learn its procedure, benefits, risks, and recovery.
Introduction
Are you struggling with the frequent, urgent, and often frustrating symptoms of an enlarged prostate? If the thought of traditional surgery feels daunting, you’re not alone. Many men seek effective alternatives with fewer risks and a quicker recovery. This guide delves into Prostate Artery Embolisation (PAE), a groundbreaking, minimally invasive procedure that is changing how we treat Benign Prostatic Hyperplasia (BPH). Unlike conventional surgeries, PAE requires no scalpels or hospital stays, offering significant relief from symptoms by precisely targeting the blood supply to the prostate. We will walk you through everything you need to know, from how the embolisation process works and who is an ideal candidate, to what you can expect during recovery and how its success compares to other treatments. If you're looking for a modern approach to reclaim your comfort and quality of life, read on to discover if PAE could be your path forward.
What is Prostate Artery Embolisation (PAE)?
Prostate Artery Embolisation (PAE) is a minimally invasive, image-guided treatment for an enlarged prostate (BPH). Performed by an interventional radiologist, it works on a simple yet clever principle: reduce the blood flow to the prostate, causing it to shrink and alleviating the pressure on the urethra.
Think of the prostate like a sponge that is saturated with water (blood). This saturation causes it to swell. PAE works by identifying the tiny arteries that feed this "sponge" and injecting microscopic particles to gently block them. This process is called embolisation. By reducing the blood supply, the prostate gland naturally shrinks over the following weeks and months. This decompression of the urethra leads to improved urine flow, less urgency, fewer nighttime trips to the bathroom, and a better overall quality of life.
How Does Shrinking the Prostate Help BPH?
BPH causes symptoms not because of the outer part of the prostate, but because the inner tissue grows and squeezes the urethra, the tube that carries urine from the bladder out of the body. This squeezing leads to a weak stream, difficulty starting urination, and a feeling of incomplete emptying. By shrinking the entire gland, PAE relieves this constriction, effectively widening the passage and restoring normal urinary function without removing any tissue.
Consult an Interventional Radiologist for the best advice
Are You a Candidate for Prostate Embolisation?
PAE is not for everyone, but it is an excellent option for a wide range of men suffering from BPH.
Ideal Candidates for PAE
- Men with moderate to severe BPH symptoms that have not responded adequately to medication.
- Men who wish to avoid the potential side effects of surgery, such as retrograde ejaculation.
- Men for whom surgery poses a high risk due to age, heart conditions, or other comorbidities.
- Men who are looking for a procedure with a shorter recovery time and no hospital admission.
Those who want to preserve sexual function.
Who Might Not Be Suitable?
- Men with prostate cancer.
- Men with certain types of bladder or kidney conditions.
Those with severe atherosclerosis (hardening of the arteries) that would make accessing the prostate arteries too difficult.
Patients with untreated urinary tract infections.
A unique insight: PAE can be a particularly valuable option for men on blood thinners that cannot be easily stopped for major surgery, as the procedure uses tiny access points that are easily managed.
PAE vs. Traditional Surgery: Understanding Your Options
- For decades, the gold standard for surgical BPH treatment has been TURP. Understanding the difference is key to making an informed choice.
Transurethral Resection of the Prostate (TURP)
TURP involves inserting a scope through the penis into the urethra and surgically cutting away pieces of the inner prostate tissue. It is highly effective but is an invasive surgery that requires spinal or general anesthesia, a hospital stay, and a catheter for several days. Common side effects include retrograde ejaculation (in up to 90% of men) and a small risk of bleeding, infection, and erectile dysfunction.
Key Advantages of Choosing PAE
- Minimally Invasive: No surgical incisions; only a tiny puncture in the wrist or groin.
- No General Anesthesia: Typically performed under local anesthesia with sedation.
- Preservation of Function: Extremely low risk of retrograde ejaculation and erectile dysfunction compared to TURP.
- Outpatient Procedure: Most patients go home the same day with just a small bandage.
- Faster Recovery: Return to normal activities within a week, versus several weeks for TURP.
- Lower Risk: Significantly reduced risk of major bleeding and transfusion.
What to Expect: The PAE Procedure Step-by-Step
Knowing what will happen can ease much of the anxiety around any medical procedure.
Pre-Procedure Preparation and Consultations
You will have a thorough consultation with a urologist and an interventional radiologist. This will include a review of your symptoms, a physical exam, and likely an MRI or ultrasound to visualize your prostate's size and shape. Blood tests and a urine flow test may also be conducted. If your symptoms are persistent and complex, consulting a urologist online with Apollo24|7 can be a convenient first step to discuss if PAE is worth exploring further.
The Day of Your Embolisation Treatment
The procedure is performed in an interventional radiology suite, not a traditional operating room.
Step 1: Local Anesthesia and Access
You will be given mild sedation to help you relax. The radiologist will numb a small area on your wrist or groin and insert a thin, flexible tube called a catheter into an artery.
Step 2: Imaging and Mapping the Arteries
Using real-time X-ray imaging (fluoroscopy), the doctor navigates the catheter toward the arteries that supply blood to your prostate. A contrast dye is injected to map the blood vessels with precision, ensuring the embolic agents are delivered exactly where needed.
Step 3: Embolic Agent Injection
Once the prostate arteries are confirmed, the doctor injects tiny microscopic particles through the catheter. These particles travel into the small vessels of the prostate, blocking them and reducing the blood flow.
Step 4: Completion and Recovery
The catheter is gently removed, and pressure is applied to the small access site to prevent bleeding. A small bandage is applied. The entire PAE procedure typically takes between 1 to 2 hours. You will then rest in a recovery room for a few hours before being able to go home.
Recovery After Prostate Artery Embolisation
Recovery from PAE is notably faster than from surgery, but it's a process of gradual improvement.
- The First 24-48 Hours
- You will need to take it easy. Some common immediate sensations include:
- Mild discomfort or a feeling of fullness in the pelvic area, similar to a slight muscle ache.
- Increased urgency or frequency to urinate for the first day or two.
- Minor blood in the semen or urine, which is normal and temporary.
- You can resume light activities within a day or two.
The First Few Weeks: Managing Symptoms
It's crucial to understand that results are not instantaneous. The prostate shrinks over time. You may experience a "flare-up" of symptoms in the first 1-3 weeks as the gland responds to the treatment. This is normal. Significant improvement in urinary flow and symptom relief usually begins within 2-4 weeks and continues to improve for up to 3 months.
Risks and Potential Side Effects of PAE
PAE is considered very safe, but like any medical procedure, it carries some risks. Serious complications are rare (<2%).
- Common & Temporary: Pelvic pain/discomfort, blood in semen or urine, increased urinary frequency, temporary difficulty urinating (may require a short-term catheter).
- Uncommon: Infection, injury to the blood vessel access site, non-target embolisation (where particles accidentally block a nearby blood vessel, which is minimized by the use of advanced imaging).
- The unique perspective: The risk of sexual dysfunction is markedly lower than with TURP. While some men may experience temporary changes, permanent erectile dysfunction is uncommon, and retrograde ejaculation is rare, making PAE a strong choice for sexually active men concerned about these side effects.
How Effective is PAE? Success Rates and Long-Term Outcomes
Clinical studies and real-world data have shown PAE to be highly effective. Research indicates that 80-90% of men see a significant improvement in their symptoms, quality of life, and urine flow rates within three months of the procedure. These results have been shown to be durable, with studies confirming sustained benefits for at least 5-10 years post-procedure. While some men may eventually require a repeat procedure or alternative treatment many years later, the initial success rates are comparable to surgery for a great number of patients, but with a superior side effect profile.
Conclusion: Is PAE the Right Choice for You?
Prostate Artery Embolisation represents a significant leap forward in the management of BPH. It offers a powerful, evidence-based alternative to traditional surgery, characterized by its minimally invasive nature, excellent safety profile, and strong focus on preserving quality of life and sexual function. If you are frustrated by medication side effects or intimidated by the prospect of surgery, PAE is a conversation worth having with your doctor.
The decision is personal and should be made in close consultation with a multidisciplinary team, including your urologist and an interventional radiologist. They can review your specific anatomy, health status, and goals to determine if you are an ideal candidate for this innovative embolisation treatment.
Consult an Interventional Radiologist for the best advice
Consult an Interventional Radiologist for the best advice
Dr Chilukuri Venkata Reddy
General Physician
4 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr G Prathyusha
General Physician/ Internal Medicine Specialist
5 Years • MBBS DNB (Family medicine), CCEBDM (Diabetology), PGDGM (Geriatrics), Primary care Rheumatologist.
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr. Sarthak Mehta
Neurologist
6 Years • MBBS , MS Mch ( Neuro )
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr Sumanth R
General Physician
2 Years • MBBS
Bengaluru
PRESTIGE SHANTHINIKETAN - SOCIETY CLINIC, Bengaluru
Dr Debnath Dwaipayan
Neurosurgeon
9 Years • MBBS, MS(Gen. Surgery), DrNB (Neurosurgery)
Delhi
Apollo Hospitals Indraprastha, Delhi
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Frequently Asked Questions
Does Prostate Artery Embolisation affect erectile function?
No, PAE has a very low risk of causing erectile dysfunction. This is a key advantage over some traditional surgical procedures. Most studies show no significant impact on erectile function.
Will I have retrograde ejaculation after PAE?
Retrograde ejaculation is uncommon after PAE, unlike after TURP where it is very common. Preservation of normal ejaculation is a major benefit for many men choosing this minimally invasive BPH treatment.
How long does it take to see the full results from the PAE procedure?
While some men notice improvement within weeks, the full benefits of PAE are typically realized within 2 to 3 months as the prostate gradually shrinks in size.
Is PAE treatment for BPH covered by insurance?
Coverage for PAE is expanding rapidly. Many major insurance providers now cover it for the treatment of BPH, especially when medications have failed. It's best to check with your specific insurance provider and your doctor's office for confirmation.
Can PAE be used to treat prostate cancer?
No. PAE is only for treating the non-cancerous growth of the prostate (BPH). It is not a treatment for prostate cancer. In fact, it can interfere with future biopsies, so a cancer diagnosis must be ruled out before proceeding with PAE.