Prostate Artery Embolization (PAE)

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, a walnut-sized organ that surrounds the urethra just below the bladder. As men age, the prostate naturally grows, and in many cases it compresses the urethra, restricting urine flow. This leads to classic symptoms: weak stream, frequent urination (especially at night), urgency, incomplete bladder emptying, and straining. BPH affects roughly 50% of men in their 50s and up to 90% of men in their 80s. It is not prostate cancer, but it significantly impairs quality of life and, if untreated, can lead to bladder damage or kidney problems.

Transurethral resection of the prostate (TURP) involves passing a surgical instrument through the urethra to physically cut and remove excess prostate tissue. While effective, TURP requires spinal or general anesthesia, an overnight hospital stay, and carries significant risks including retrograde ejaculation (semen flows backward into the bladder) in 65–90% of patients, erectile dysfunction in 10–15%, urinary incontinence in 1–5%, and bleeding requiring transfusion. PAE, by contrast, is performed through a tiny wrist or groin puncture under mild sedation. It achieves comparable symptom improvement by shrinking the prostate from within — without any instrument entering the urethra — and carries a near-zero risk of sexual side effects.

Ideal PAE candidates are men with moderate-to-severe BPH symptoms (International Prostate Symptom Score ≥ 8), a prostate volume typically between 40 and 200+ grams, and who have failed or wish to avoid medication side effects, or who want to preserve sexual function and avoid surgery. Men with very small prostates, urethral strictures, or certain arterial anatomies may not be optimal candidates. A consultation with Dr. Chahal, including a review of prior imaging and lab work (including PSA), is the first step to determining candidacy.

You arrive at the office-based lab, receive IV access and mild conscious sedation (you’re relaxed but not fully asleep), and the access site — typically the right wrist — is numbed with local anesthetic. Dr. Chahal places a small sheath into the radial artery and threads a microcatheter under live X-ray guidance to the bilateral prostatic arteries. Tiny embolic microspheres (roughly the diameter of a human hair) are then injected, selectively reducing blood supply to the enlarged prostatic tissue. The procedure takes 60–120 minutes depending on anatomy. A brief recovery period follows, and most patients go home the same afternoon.

Most patients begin noticing improvement in urinary symptoms within 2–4 weeks. The prostate continues to shrink over 3–6 months as the treated tissue softens and is reabsorbed. In clinical studies, peak symptom improvement is typically measured at 3–6 months post-procedure. Some men experience mild temporary worsening of symptoms in the first 1–2 weeks due to post-procedural inflammation — this is normal and resolves. At 12 months, approximately 83% of patients report clinically meaningful symptom improvement.

PAE has a strong safety profile with major complication rates below 2% in large published series. The most common side effect is post-embolization syndrome: temporary flu-like symptoms (low-grade fever, fatigue, pelvic discomfort) for 3–7 days after the procedure — this is expected and manageable with ibuprofen and hydration. Less common complications include urinary tract infection (<5%), temporary urinary retention requiring a short-term catheter (<5%), and bladder or rectal irritation from inadvertent non-target embolization (<1% in experienced hands). Long-term sexual side effects are exceedingly rare, making PAE particularly appealing to sexually active men.

No. PAE is specifically indicated for the urinary symptoms of benign prostatic hyperplasia (BPH) and is not a treatment for prostate cancer. However, patients with a concurrent BPH and low-risk prostate cancer may still be candidates — the PAE addresses their urinary symptoms while the cancer is managed separately with active surveillance or other therapies. All patients undergo PSA testing and clinical prostate evaluation before PAE to ensure no undiagnosed prostate cancer is present.

Published data out to 5–7 years shows durable symptom control in the majority of patients. In long-term follow-up studies, roughly 75–80% of men who respond to PAE maintain significant symptom improvement at 5 years without need for surgical re-intervention. A minority of patients (approximately 10–15%) may eventually require additional treatment as the prostate can continue to grow with age, but PAE does not preclude future TURP or other surgical options if needed.

PAE has established CPT billing codes (37243 for embolization, 36247 for catheterization) and is covered by Medicare and most major commercial insurers when documentation supports medical necessity — namely, failed or intolerable medical therapy and appropriate symptom burden. Our team provides full prior authorization support and works proactively to secure coverage before your procedure date.

UroLift uses tiny implants to hold back prostate tissue (no tissue removal) and is best for smaller prostates with a specific anatomy; it preserves ejaculation but involves a urethral procedure. Rezūm uses steam to destroy tissue via the urethra under anesthesia. PAE is the only technique that treats the prostate entirely from outside the urinary tract, making it ideal for larger glands (>80cc), patients who have failed UroLift or Rezūm, and those who strongly wish to avoid anything passing through the urethra. Each technology has a different efficacy and risk profile, and the best choice depends on anatomy, prostate size, symptom pattern, and patient preference — Dr. Chahal will review all options at your consultation.