Living with an enlarged prostate can make normal daily activities difficult. You may need to visit the washroom frequently, wake up several times during the night, struggle to start urination, or feel that your bladder has not emptied completely. When medicines do not provide adequate relief, prostate artery embolisation (PAE) is one minimally invasive treatment that may be considered.
PAE works differently from conventional prostate surgery. An interventional radiologist guides a thin catheter through the blood vessels to the arteries supplying the prostate. Tiny embolic particles are then delivered to reduce blood flow to selected prostate tissue. Over time, the prostate can shrink, potentially reducing pressure on the urinary passage and improving BPH symptoms.
However, does that mean everyone with an enlarged prostate can undergo PAE? Not exactly. Patient selection is extremely important because urinary symptoms, prostate anatomy, and overall medical condition can differ considerably from one person to another.
So, which patients should avoid prostate artery embolisation? Let us understand.
Who Can Consider Prostate Artery Embolisation?
Before discussing who should avoid the procedure, you may be wondering who is eligible for prostate artery embolisation.
PAE may be considered for appropriately selected men with bothersome lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH), particularly when medication has not provided sufficient relief, causes unwanted effects, or a minimally invasive option is being considered.
However, having an enlarged prostate alone does not determine suitability.
| PAE may be considered when | PAE may not be suitable when |
| Urinary symptoms are primarily related to BPH | Symptoms have another important underlying cause |
| Medicines are not providing adequate relief | Prostate cancer is suspected and requires evaluation |
| A minimally invasive treatment is being considered | Pelvic arterial anatomy makes embolisation unsuitable |
| Prostate and vascular anatomy are appropriate | Significant bladder dysfunction contributes to symptoms |
| Specialist assessment confirms suitability | Another BPH treatment is considered more appropriate |
Hence, proper evaluation is an important part of deciding whether PAE is the right treatment.
When BPH Is Not the Main Cause of Symptoms
BPH is automatically caused by frequent urination, urgency, and weak urine flow, right? Not necessarily.
The same symptoms may happen due to urethral constriction, bladder dysfunction, neurological disorders,s and other urinary issues. In cases where the enlarged prostate is not the main cause of the symptoms, the solution may not be adequate to decrease the blood supply to the enlarged prostate.
Therefore, it is significant to determine the real cause of urinary symptoms prior to the selection of PAE.
When Prostate Cancer needs to be investigated.
PAE is applied in the treatment of urinary symptoms of benign prostate enlargement. It is not a treatment of prostate cancer.
In case PSA results, clinical examination, imaging, NG, or other findings give a suspicion of prostate cancer, further investigation might be required before treatment of BPH is done. BPH and prostate cancer may co-exist.
Therefore, pre-PAE prostate assessment is not just a matter of finding out the size of the prostate.
In case of Arterial Anatomy Inappropriateness.
Interestingly, PAE treatment does not go to the prostate via the urethra but via its blood vessels. Thus, the arrangement of these blood vessels is important.
It may be challenging to safely access the prostate arteries in severe atherosclerosis, extensive arterial calcification or very tortuous pelvic arteries. These vascular factors may render PAE technically difficult or inappropriate in some patients.
Imaging and procedural planning help an interventional radiologist understand the arteries of the pelvis and whether embolisation is safe or not.
In the case of Bladder Problems as well.
What is the effect of having a large prostate and a poor bladder?
Difficulty emptying the bladder may be caused by poor bladder muscle or neurological bladder issues. Bladder stones, large diverticula, and other urinary anomalies might also require independent assessment.
The desired effect may not be attained by the treatment of the prostate itself in this case. This is why a complete assessment is more useful than the choice of treatment according to the size of the prostate.
Where some other Relief is required.
PAE does not physically cut away prostate tissue. Rather, it decreases blood flow such that the treated prostate tissue slowly shrinks.
This is significant when talking about PAE recovery time. Simple minimally invasive surgery can have a relatively quick recovery, but the urinary symptoms do not necessarily improve immediately. The prostate will react slowly, and the symptoms can be improved in the following weeks and months.
Therefore, there are patients who might be more appropriate for another BPH procedure based on the level of obstruction, clinical presentation, and treatment objectives.
PAE vs TURP: Are they similar?
A common comparison that is made in terms of treating an enlarged prostate is PAE vs TURP.
They are very dissimilar processes. TURP eliminates the blocking prostate tissue via the urethra. PAE, in turn, decreases the blood supply to the chosen prostate tissue via the arteries.
The other question that patients usually ask is: Is PAE safer than TURP? Comparative studies have reported fewer adverse events with PAE in certain settings, but TURP may be more beneficial in certain objective measures of urinary obstruction. It is also evidenced that additional treatment of BPH may be more common following PAE than following TURP.
Therefore, there is no way that either of the procedures can be proclaimed superior to all patients. The therapy should be founded on individual symptoms, anatomy, medical condition, and priorities.
What Is the Success of PAE?
It is understandable that patients would be interested in knowing the success rate of the prostate artery embolisation prior to treatment.
The outcome of all patients cannot be predicted using a particular percentage. Clinical trials suggest that PAE can be of great value in urinary symptoms and quality of life in selected patients. Nevertheless, the results are determined by the prostate anatomy, arterial anatomy, the severity and cause of symptoms, and the duration of follow-up.
Therefore, good patient selection is an important part of achieving a satisfactory outcome.
Does Prostate Artery Embolisation Hurt?
The other question that is often posed is: Is prostate artery embolisation painful?
PAE is normally performed under local anaesthesia at the point of arterial access, and sedation is given depending on the needs of the patient and clinical practice. But it would not be right to say that the procedure is entirely painless.
There are some patients who have temporary pelvic pain, urinary irritation, or pain after embolisation. The treating team can explain to the patient what symptoms are normal during the recovery process and what symptoms require medical attention.
What are the Side Effects?
PAE, just like any medical procedure, has potential risks. Pelvic pain, urinary frequency or urgency, painful urination, blood in the urine or semen, nausea, and post-embolisation symptoms are the most common or transient side effects of prostate artery embolisation.
Rarely, there may be complications at the arterial access site. Another uncommon but serious risk is non-target embolisation, where the embolic material gets into blood vessels that supply other tissues rather than only the target prostate tissue.
Selective catheter placement and proper expertise, as well as careful arterial mapping, are thus significant during PAE.
What About Sexual Function After PAE?
For many men, sexual function is an important factor when comparing BPH treatments. So, does PAE affect sexual function?
Research suggests that PAE generally has a lower risk of ejaculatory dysfunction than TURP. However, this does not mean that every patient is guaranteed to have unchanged sexual or ejaculatory function following treatment.
Existing erectile function, age, medications and other health conditions may also influence sexual health. Hence, patients concerned about sexual function should discuss this specifically during their consultation.
Why Proper Patient Selection Matters
The important thing to remember is that PAE is not simply a non-surgical procedure that can be offered to every patient with an enlarged prostate. Before treatment, a specialist may need to consider:
- Whether BPH is actually causing the urinary symptoms
- Severity of symptoms and their effect on everyday life
- Previous treatment and response to BPH medicines
- Prostate size and anatomy
- Prostate cancer risk when clinically appropriate
- Bladder and urinary tract function
- Pelvic arterial anatomy
- Existing health conditions and medications
These factors help determine whether PAE is likely to offer meaningful benefit or whether another treatment would be more appropriate.
Considering Minimally Invasive Treatment for BPH?
If an enlarged prostate is affecting your sleep, comfort, or everyday activities, getting properly evaluated can help you understand your treatment options. The objective should not simply be to avoid surgery. Instead, it should be to find a treatment that suits the actual cause and severity of your symptoms.
C3 Medicare provides Interventional Radiology services and minimally invasive procedures for conditions including benign prostatic hyperplasia. Patients considering prostate artery embolisation can consult the team for an individual assessment and to understand whether PAE may be suitable for their condition.
If you are struggling with symptoms of an enlarged prostate and want to explore a minimally invasive treatment option, contact C3 Medicare for an appointment. A detailed evaluation can help you understand whether PAE is appropriate for you and what you can realistically expect from the treatment.
This article is intended for general informational purposes and does not replace personalised medical advice, diagnosis or treatment from a qualified healthcare professional.
