Prostate Artery Embolization: Answers to Frequently Asked Questions

Since the FDA approved prostate artery embolization (PAE) for enlarged prostates in 2018, scores of our patients have asked about this drug-free method to relieve lower urinary tract symptoms.

After experiencing the frustration of awakening multiple times at night to urinate or worrying whether you can sit through a long meal or car drive, learning that doctors can painlessly shrink your prostate tissue without medication can be a real eye-opener.

Based on a growing body of evidence, as well as our own patient feedback, the success rates of PAE are promising. Is PAE right for you? Let’s explore.

Wait, What is Prostate Artery Embolization?

PAE is an outpatient procedure that blocks the blood supply to the prostate’s enlarged tissue. This is essential because blood nourishes our tissue and bones. In the case of an enlarged prostate, however, the tissue is outgrowing its residence in the prostate and causing problems. Here’s how.

The prostate starts out as a little gland with an important job: making the fluid that carries sperm. It’s positioned at the neck of the bladder and surrounds the urethra, the tube that carries urine.

At the age of 25 or so, the gland enters a slow, lifelong growth stage. After a few decades, the prostate’s tissue can become so enlarged that it pushes against the urethra, making it hard for the bladder to squeeze out urine. This is called benign prostatic hyperplasia (BPH), and can lead to bladder infections and other health issues.

Half of all men have an enlarged prostate by the age of 60; 70% experience symptoms by age 69; and 90% have it by the time they are 85.

Some of the most common symptoms include:

• A need to urinate more frequently and urgently, especially at night.
• Trouble starting to urinate, with possible straining.
• A weak, stop-and-start urine stream.
• Feeling like your bladder won’t empty.

How Do I Know PAE Is Right for Me?

If you experience the above symptoms for more than a few weeks, it might be time to consult a urologist who can perform a physical exam and check your blood and urine, bladder function, and urine flow.

PAE won’t necessarily be the initial course of action if you have BPH. Typically, doctors advise lifestyle adjustments, such as avoiding caffeine and alcohol. They may prescribe medications that relax the prostate and bladder muscles or shrink the tissue by reducing hormone production.

When modifications and medications fail to ease symptoms, the next step has traditionally been to remove the enlarged tissue. Options include laser removal, waterjets (Aquablation Therapy), microwave therapy, or surgical cutting.

We also offer an alternative to tissue removal called UroLift, in which tiny prostatic implants, delivered through the urethra, pull the enlarged tissue back.

How Safe and Effective is PAE?

Prostate artery embolization is a different approach. It actually shrinks the tissue and prevents further growth. Spokane Urology provides PAE as part of its interventional radiology (image-guided, minimally invasive services) through a partnership with Inland Imaging.

Here’s how it’s done:

• You’ll be placed under light sedation, so be sure to arrange for a safe ride home.
• Once you are in twilight sleep, an interventional radiologist inserts a slim, flexible tube (catheter) into an artery in your upper thigh or wrist through a needle puncture.
• The IR specialist uses X-ray images to guide the catheter to your prostate, then injects a dye to reveal which arteries feed blood to the enlarged tissue.
• Continuing to use X-ray guidance, the physician shoots tiny beads toward those arteries, where the beads lodge, blocking blood flow.
• Without blood to feed it, the enlarged tissue shrinks.

After the procedure, you might feel some soreness in the pelvic area. Within three weeks, you should feel improvements.

What Success Rates Do PAE Studies Report?

Some patients wonder how long PAE lasts, and researchers are keeping favorable tabs on that. In one study detailed in the National Library of Medicine, PAE patients reported:

• An 85% success rate in relieving symptoms for one year;
• A nearly 82% success rate for up to three years; and
• A more than 76% success rate three to 6.5 years after a PAE.

Further, PAE patients are less likely to experience ejaculation issues compared with surgery patients, Endovascular Today reports. And the risks of sexual dysfunction and urinary incontinence are lower than with some surgeries.

Thanks to its efficiency, the cost of PAE is lower than surgery and minimally invasive treatments, and it is covered by most insurance plans.

Ask About PAE

You can learn about Spokane Urology’s interventional radiology services here. If you’re interested in more detail about PAE, download our BPH educational handout or read out introductory blog about PAE.