Prostate Artery Embolization (PAE) FAQs: What Men in Columbia and Mid-Missouri Should Know

Based on a patient education PAE webinar with Kavi Devulapalli, MD, interventional radiologist.

Prostate artery embolization, or PAE, is a minimally invasive treatment for urinary symptoms caused by an enlarged prostate, also known as benign prostatic hyperplasia or BPH. PAE works by reducing blood flow to selected areas of the prostate, allowing the gland to gradually shrink and relieve pressure on the urethra. For appropriately selected patients, it can provide another option between long-term medication and traditional prostate surgery.

Image Guided Solutions of Missouri offers prostate artery embolization in Columbia, Missouri, for men throughout Mid-Missouri and the surrounding region who want to understand whether PAE may be appropriate for their enlarged prostate symptoms.

The American Urological Association's current BPH guideline states that PAE may be offered for lower urinary tract symptoms caused by BPH when it is performed by a clinician trained in the interventional radiology procedure after a discussion of potential risks and benefits. American Urological Association BPH Guideline

What is prostate artery embolization?

Prostate artery embolization is an image-guided, minimally invasive procedure used to treat urinary symptoms caused by an enlarged prostate. Instead of surgically removing prostate tissue, an interventional radiologist treats the prostate through its blood vessels.

During PAE, a very small catheter is introduced into an artery through a tiny access point, typically near the hip or, in some patients, through the wrist. Using live X-ray imaging, the physician guides the catheter into the arteries supplying the prostate.

Microscopic particles are then delivered into selected prostate arteries. These particles decrease blood flow to portions of the prostate, which causes the gland to gradually shrink.

As the prostate becomes smaller, pressure around the urethra can decrease and urinary symptoms may improve.

The Society of Interventional Radiology describes PAE as a minimally invasive treatment in which image guidance is used to direct a catheter to the prostate's blood vessels and reduce blood flow to targeted areas of the gland. Society of Interventional Radiology patient information

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What symptoms may mean I have an enlarged prostate?

Benign prostatic hyperplasia becomes increasingly common as men age. When the prostate enlarges, it can compress the urethra and make it more difficult for the bladder to empty.

• Frequent urination
• Waking repeatedly at night to urinate
• Urinary urgency
• Weak urinary stream
• Difficulty starting urination
• Feeling that the bladder has not completely emptied
• Dribbling
• Urinary retention in more severe cases

These symptoms are often called lower urinary tract symptoms, or LUTS.

BPH is not prostate cancer, although the two conditions can occur at the same time. Other conditions can also produce similar urinary symptoms, which is why an appropriate medical evaluation remains important. NIDDK prostate conditions information

When should I consider PAE instead of continuing medication?

Medication is often an appropriate first treatment for BPH. Medications such as alpha blockers, including tamsulosin, can improve urinary symptoms for many men. Other medications may reduce prostate growth or address different components of BPH.

PAE may become worth discussing when:

• Symptoms continue despite medication
• Medication is no longer controlling symptoms adequately
• Side effects are becoming difficult to tolerate
• You do not want to continue adding or taking medications indefinitely
• BPH is substantially affecting sleep or daily life
• You want to understand options other than traditional prostate surgery

There can feel like a significant jump between taking medication and undergoing surgery. For some appropriately selected patients, PAE can provide another option within that treatment spectrum.

How is PAE different from TURP?

TURP and PAE treat BPH in fundamentally different ways.

Transurethral resection of the prostate, or TURP, is a well-established urologic procedure in which prostate tissue obstructing urine flow is removed through the urethra.

PAE does not physically remove prostate tissue. Instead, an interventional radiologist works through the arteries and reduces blood flow to selected portions of the prostate so it gradually shrinks.

TURP can produce substantial symptom improvement relatively quickly. PAE typically produces improvement more gradually because the prostate needs time to shrink.

For some patients, the appeal of PAE is avoiding a traditional surgical approach, general anesthesia, and instrumentation through the urethra. Which treatment is appropriate depends on prostate anatomy, symptoms, medical history, treatment goals, and physician evaluation.

How does PAE compare with HoLEP?

Holmium laser enucleation of the prostate, or HoLEP, is another established treatment for BPH. During HoLEP, a urologist uses a laser to remove obstructing prostate tissue.

HoLEP can be highly effective and is considered a prostate-size-independent surgical treatment option in American Urological Association guidance. AUA BPH Guideline

PAE takes a different approach because no prostate tissue is surgically removed.

For patients comparing PAE and HoLEP, the discussion often involves:

• Prostate size and anatomy
• Arterial anatomy
• Severity of urinary symptoms
• Desired speed of improvement
• Recovery expectations
• Surgical and anesthesia considerations
• Sexual function considerations
• Other health conditions

Neither treatment is automatically the right option for every patient. The goal is to match the treatment to the individual.

Does prostate size affect whether I can have PAE?

Both smaller and larger prostates may potentially be treated with PAE, but prostate size and anatomy can affect technical difficulty and treatment planning.

Dr. Devulapalli explained that very large prostates can be particularly appropriate to evaluate for PAE because some other treatment choices may become more limited as prostate size increases.

Smaller prostates do not automatically eliminate PAE as an option. However, the blood vessels supplying a smaller prostate can sometimes make the procedure technically more challenging.

A consultation and appropriate imaging help determine whether the patient's individual anatomy makes PAE a reasonable option.

Can I have PAE if I have heart or leg stents?

Having vascular or coronary stents does not automatically disqualify someone from PAE.

What matters is whether the interventional radiologist can safely navigate the arteries needed to reach the prostate.

Previous stents, arterial plaque, tortuous blood vessels, and other vascular conditions can influence how the procedure is approached. In some cases, an alternative arterial access route may be considered.

This decision is individualized after reviewing medical history and imaging.

Is prostate artery embolization performed under general anesthesia?

PAE at Image Guided Solutions of Missouri is generally performed using local anesthetic and moderate or light sedation rather than general anesthesia.

The skin around the vascular access point is numbed, and medications can be used to help the patient relax and remain comfortable.

Because sedation is used, patients need someone to drive them home after the procedure.

How long does a PAE procedure take?

Procedure time varies based largely on a patient's vascular anatomy.

In straightforward anatomy, PAE may sometimes be completed in less than an hour. More complex arteries, vascular plaque, or challenging anatomy can make the procedure take longer, sometimes approaching two hours.

Patients typically spend additional time before and after treatment for preparation and recovery. PAE is performed on an outpatient basis, so patients generally return home the same day.

Will I need a urinary catheter after PAE?

Most men who do not already have a catheter do not routinely require one following PAE.

The likelihood of needing a catheter after the procedure is relatively low in his practice.

Patients who already have a catheter because severe BPH has caused urinary retention may still be evaluated for PAE. In those cases, the procedure can be performed with the existing catheter in place and a later trial of catheter removal may be planned as the prostate begins to shrink.

Individual circumstances vary, particularly for men with significant urinary retention.

What is recovery like after prostate artery embolization?

PAE recovery is generally relatively short compared with more invasive prostate procedures.

During the first few days after treatment, patients may experience:

• Increased urinary frequency
• Urinary urgency
• Pelvic or urinary discomfort
• Temporary inflammation
• Mild fatigue

Medication can be prescribed when needed to help manage these symptoms.

Dr. Devulapalli generally advises patients to avoid heavy lifting and strenuous physical activity during approximately the first week after treatment. This helps protect the small arterial access site while it heals.

Many patients can otherwise return to their usual routine relatively quickly.

How quickly will PAE improve my enlarged prostate symptoms?

PAE works gradually rather than immediately.

Reducing blood flow to the prostate initiates a process in which the gland slowly shrinks. Dr. Devulapalli tells patients to think of it somewhat like putting the prostate 'on a diet.' The change occurs over time rather than overnight.

Some patients begin noticing improvement at approximately one month. Improvement may become more noticeable over the next 1 to 3 months.

A stronger urinary stream and better bladder emptying may be among the first changes patients recognize. Nighttime urination can sometimes take longer to improve.

The speed and amount of improvement vary from person to person.

Will PAE affect erections or sexual function?

PAE is not a treatment for erectile dysfunction.

If erectile dysfunction began as a side effect of BPH medication, successfully treating urinary symptoms and eventually reducing the need for that medication could potentially affect that situation. That should be discussed individually with the treating physician.

PAE itself is designed to treat the prostate through its arterial blood supply rather than removing tissue through the urethra. The Society of Interventional Radiology notes that PAE has a lower risk of the sexual side effects typically associated with some invasive prostate surgeries. Society of Interventional Radiology

Patients who are especially concerned about erectile or ejaculatory function should specifically discuss that priority when comparing BPH treatment options.

Do I stop taking prostate medication immediately after PAE?

Usually not.

At Image Guided Solutions of Missouri, patients may continue their BPH medication during the early recovery period while the prostate begins to shrink.

Many patients remain on medication for approximately the first month. If urinary symptoms have improved sufficiently, medication may be reduced or discontinued under a physician's guidance.

Some patients may need medication longer. Do not discontinue a prescribed prostate medication without discussing it with the clinician managing your treatment.

Should I see a urologist before having PAE?

A urologic evaluation is often valuable.

PAE treats urinary symptoms caused by BPH, but not every urinary problem is caused by an enlarged prostate. Similar symptoms may occur with bladder disorders, strictures, infection, neurologic problems, prostate cancer, or other conditions.

Image Guided Solutions of Missouri works collaboratively with urologists and can obtain records and coordinate care when appropriate.

This is not an either-or relationship. Interventional radiology and urology can play complementary roles in determining the most appropriate treatment.

Does PAE increase the risk of prostate cancer?

PAE is not known to cause prostate cancer. BPH and prostate cancer are separate conditions.

However, the two can coexist.

That is why prostate evaluation before PAE matters. Depending on age, PSA level, medical history, previous testing, and other factors, additional evaluation may be appropriate before treatment.

Prostate procedures may also affect PSA measurements, which can complicate interpretation for a period afterward.

If prostate cancer is suspected, the goal is to address that question before proceeding with treatment for BPH.

Can I have PAE if I already have low-risk prostate cancer?

Potentially.

Dr. Devulapalli explained that some men with known low-risk prostate cancer who are being managed with active surveillance may still be candidates for PAE.

The important consideration is making sure the cancer has been appropriately evaluated and remains under surveillance.

That can involve reviewing:

• Previous biopsy results
• PSA history
• Prostate MRI
• Urology records
• Current surveillance recommendations

PAE does not replace prostate cancer surveillance or treatment.

Is PAE permanent?

PAE can provide long-lasting relief, but no BPH treatment guarantees that the prostate will never grow again.

Prostate tissue can gradually regrow over the years after PAE or after surgical BPH treatments.

That means urinary symptoms can potentially return later in life.

If symptoms eventually recur, the patient can be reevaluated. In appropriate circumstances, PAE may be repeatable or another BPH treatment may be considered.

Can prostate artery embolization be reversed?

The embolization particles used during PAE are not simply removed after the procedure.

Once the targeted arteries have been embolized, those specific vascular changes are not reversed by retrieving the particles.

However, the prostate itself can gradually develop additional blood supply and regrow over time. That is one reason BPH symptoms can eventually recur in some men years after treatment.

Can someone with immune system problems have PAE?

Immune system conditions do not necessarily exclude a patient from prostate artery embolization.

However, candidacy depends on the individual's condition, medications, infection risk, vascular anatomy, and other medical factors.

Patients with significant medical conditions should provide a complete medical history so that the interventional radiologist can evaluate the procedure safely.

Is PAE covered by insurance or Medicare?

Coverage depends on the patient's insurance plan, indication, documentation, and individual benefits.

PAE has become an established treatment option within contemporary BPH care. The current American Urological Association guideline states that PAE may be offered for LUTS/BPH when performed by a clinician trained in the procedure following discussion of risks and benefits. AUA BPH Guideline

The Society of Interventional Radiology also provides resources for patients dealing with insurance authorization or coverage issues related to PAE. SIR PAE insurance resource

Image Guided Solutions of Missouri can help patients understand the authorization process for their specific coverage.

Where can I get prostate artery embolization in Columbia, Missouri?

Image Guided Solutions of Missouri provides prostate artery embolization in Columbia, Missouri, for appropriately selected patients with BPH from Columbia, Mid-Missouri, and communities throughout Missouri.

PAE is performed by Dr. Kavi Devulapalli, an interventional radiologist, using image-guided techniques to treat the arteries supplying the prostate.

Patients can start by discussing their symptoms, previous BPH treatment, medications, prostate evaluation, and treatment goals with the Image Guided Solutions team.

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Frequently Asked Questions About PAE

Is prostate artery embolization a surgery?

No. PAE is a minimally invasive, image-guided procedure performed through the arteries by an interventional radiologist. It does not involve surgically removing prostate tissue.

How long does it take to recover from PAE?

All patients go home the same day. Patients are generally advised to avoid heavy lifting and strenuous activity for approximately the first week, although recovery varies by individual.

When will I notice improvement after PAE?

PAE works gradually as the prostate shrinks. Some patients begin noticing urinary improvement around one month after treatment, with additional improvement developing during the following several months.

Does PAE require a urinary catheter?

Most patients who do not already have a catheter do not routinely need one after PAE. Patients with severe urinary retention who already have a catheter may still be candidates for treatment.

Does PAE cause sexual side effects?

PAE is designed to treat the prostate through the arteries rather than surgically removing tissue through the urethra. It generally has a lower risk of sexual side effects than some more invasive prostate procedures, but every procedure has potential risks that should be discussed with your physician.

Where is PAE available in Mid-Missouri?

Image Guided Solutions of Missouri offers prostate artery embolization in Columbia, Missouri, for patients from Columbia, Mid-Missouri and across the state who are appropriate candidates for the procedure.
This article is for educational purposes only and is not a substitute for individualized medical advice. Symptoms, candidacy, treatment options, risks, benefits, and expected outcomes should be discussed with a qualified healthcare professional.

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Sources and Medical References

• American Urological Association, BPH Guideline
• Society of Interventional Radiology, Enlarged Prostate / PAE
• National Institute of Diabetes and Digestive and Kidney Diseases, Prostate Problems
• Society of Interventional Radiology, PAE Insurance Appeal Resource