An expert guide to prostate artery embolisation (PAE)

Prostate artery embolisation (PAE) is an established, image-guided treatment option for men with benign prostatic hyperplasia (BPH) who are troubled by urinary symptoms and are seeking an alternative to surgery.

Understanding prostate embolisation

Prostate embolisation is a non-surgical procedure that reduces the size of an enlarged prostate by selectively blocking its blood supply. Using real-time imaging guidance, liquid embolic glue is delivered into the arteries feeding the prostate. This reduces blood flow, leading to gradual shrinkage of the gland and relief of pressure on the urethra.

An interventional radiologist’s role is to combine detailed anatomical imaging with precise catheter techniques to treat the prostate while preserving surrounding structures such as the bladder, rectum and sexual nerves.

Who may benefit from prostate embolisation?

PAE is most often considered for men with moderate to severe urinary symptoms caused by BPH who have not responded adequately to medication or who cannot tolerate its side effects. It can be particularly suitable for men who wish to avoid traditional prostate surgery, or for those with other medical conditions that make surgery higher risk.

A detailed assessment is essential and typically includes prostate imaging, urinary symptom scoring, blood tests and discussion within a multidisciplinary team to ensure PAE is an appropriate option.

What happens during the procedure?

Prostate embolisation is performed under local anaesthetic. A small catheter is inserted into an artery, usually at the wrist or groin, and guided under X-ray control to the prostate arteries. Advanced imaging is used to map the blood supply in detail before embolisation takes place.

Patients can expect:

• detailed imaging to identify prostate arteries and anatomical variants
• selective catheterisation of arteries supplying the prostate
• controlled delivery of liquid embolic agent glue
• continuous imaging to protect nearby organs
• same-day or overnight hospital stay in most cases

The procedure usually takes one to two hours, depending on individual anatomy.

Recovery and symptom improvement

Most men return home the same day or the following day. Temporary side effects such as pelvic discomfort, increased urinary frequency or mild flu-like symptoms can occur but usually settle within days.

Symptom improvement is gradual, with most men noticing better urinary flow and reduced frequency over several weeks as the prostate shrinks. From a radiologist’s viewpoint, follow-up imaging and clinical review are important to confirm treatment success and monitor long-term outcomes.

Safety and effectiveness

Evidence shows that prostate embolisation can significantly improve urinary symptoms and quality of life for appropriately selected patients. The risk of sexual side effects such as erectile dysfunction or ejaculation problems is low compared with some surgical treatments.

As with any procedure, careful patient selection and experienced image-guided technique are key to achieving good results.

A radiology-led treatment option

Prostate embolisation highlights how modern interventional radiology can offer effective, organ-preserving treatments using imaging rather than open surgery. For men with BPH who are exploring alternatives to conventional surgical approaches, PAE can be a valuable option when assessed and performed by an experienced consultant interventional radiologist working closely with urology colleagues.