Prostatic Artery Embolization

A Minimally-Invasive Treatment for Prostate Enlargement

ColumbiaDoctors interventional radiologists are experts in prostatic artery embolization, a relatively new and minimally-invasive treatment for benign prostatic hyperplasia (BPH)—also known as prostate enlargement—that eliminates many of the side effects associated with medications and surgical treatments.

Using image guidance and minimally-invasive tools, our interventional radiologists perform thousands of procedures each year to treat BPH and other conditions that would otherwise require open surgery. Most of the time, this means that patients go home on the day of their procedure with a Band-Aid instead of an incision.

A consultation with an interventional radiologist can help determine whether prostatic artery embolization is the right treatment for you.

BPH Treatment at ColumbiaDoctors Interventional Radiology

Physician points to screen while talking to male patient.

BPH is a noncancerous, common condition in which the prostate becomes enlarged and constricts or blocks the urethra, causing urinary symptoms. More than half of men over the age of 60 have some urinary symptoms due to BPH and up to 90 percent of men aged 70 to 89 experience symptoms.

Symptoms of BPH include frequent urination, incomplete emptying of the bladder, difficulty urinating, and incontinence. For some patients, symptoms interfere with daily activity and sleep. BPH does not require treatment unless the symptoms interfere with quality of life. 

Prostatic artery embolization is a minimally invasive, safe, and highly effective treatment for BPH. During this procedure an interventional radiologist uses X-ray imaging to navigate a catheter (a thin, hollow tube) to the vessels that supply the prostate with blood.  Tiny round beads—each measuring the size of a grain of sand—are injected into the catheter and into the prostate-feeding vessels. The tiny beads block the blood flow to the prostate, causing it to shrink. 

Am I a candidate for prostatic artery embolization?

Patients who are ideal candidates for prostatic artery embolization include men who:

  • Have symptomatic BPH
  • Want to preserve sexual function
  • Have had an adverse reaction to or side effects from medications
  • Don’t want or might not be good candidates for surgery

Recent studies have shown that close to 90% of patients demonstrate improvement after prostatic artery embolization, with many patients showing up to ten years of good long-term results.

Your interventional radiologist will schedule an exam to determine if you are a candidate for prostatic artery embolization. The exam may include a health history, urine test, rectal exam, and X-ray or ultrasound imaging to determine the size of the prostate.  As with any medical intervention, discuss the most current clinical data with your interventional radiologist before deciding on the treatment that is best for you.

What will happen during the procedure?

After midnight on the evening before your procedure you should not eat or drink anything. Your doctor will tell you which medications you may take in the morning.

After you arrive in one of our outpatient offices and are ready for the procedure, we will administer a local anesthetic to numb your wrist or groin area, then insert a needle. This needle provides access for a catheter, which we will guide to the vessels that supply blood to the prostate. Your doctor will use an X-ray technique called fluoroscopy to guide the catheter into position.

Once the catheter is in place, we will inject a contrast dye—which enables us to see the blood supply to the prostate—into the vessels. After this procedure, called an arteriogram, we will slowly inject an embolic (blocking) agent (synthetic particles the size of grains of sand) into the artery through the catheter. The embolic agent flows with the blood toward the prostate and becomes wedged in the vessels supplying the prostate with blood. We will continue the procedure for several minutes until the blood flow is completely blocked, and then move the catheter to the other side of the prostate and repeat the process.

We routinely perform prostatic artery embolization in under an hour, and you will then recover in your own private room. Most patients return to work in under a week.

Are there any risks?

The procedure is relatively safe when performed by an experienced interventional radiologist. Major complications include:

  • Post-PAE syndrome consisting of pain, nausea, low-grade fever, and/or painful urination

Please discuss all risks and benefits with your interventional radiologist during your consultation.

After the procedure

Most patients are scheduled as the first case of the day in our outpatient office and recover in their own private room, going home in the late afternoon. You will likely need about four days at home to recover, and most patients feel back to normal after a week to 10 days.

Most men experience six to 12 hours of discomfort after the procedure. We usually treat your pain with an oral or intravenous painkiller while you're in the hospital. The pain usually decreases during the first week and can be controlled with an oral painkiller.

Follow-up

We will schedule a follow-up appointment for you within a week to a month after the procedure, and we may order imaging tests to check the status of the prostate three to six months after the procedure.