Prostatic Artery Embolization: A Revolutionary Approach to Treating Enlarged Prostate
For millions of men worldwide, benign prostatic hyperplasia (BPH) means a life disrupted by frequent urination, sleep deprivation, and diminished quality of life. While conventional treatments often force patients to choose between ineffective medications or invasive surgical procedures with significant surgery side effects, prostatic artery embolization (PAE) offers a revolutionary alternative. This minimally invasive procedure provides substantial symptom relief without sexual dysfunction, incontinence, or extended recovery. Particularly effective for larger prostates and bothersome symptoms of benign prostatic hyperplasia, PAE requires only local anesthesia with patients returning to normal activities within 1-2 days. Discover how this breakthrough benign prostate enlargement treatment is transforming disease management.
Benign Prostatic Hyperplasia: A Global Health Challenge
Benign prostatic hyperplasia symptoms represent one of the most widespread health challenges for men worldwide. This non-cancerous enlargement of the prostate gland affects approximately 45% of men over 45 years of age, with the prevalence increasing to about 80% in men over 70.
The burden of BPH varies significantly across regions and socioeconomic statuses. Middle-SDI (Socio-Demographic Index) regions face the heaviest absolute burden. The global 65-69 age group bears the highest burden, with concerning increasing trends in both the 40-44 and 80+ age groups.
As our medical team has observed through years of research and patient consultations, BPH significantly impacts quality of life. The condition is associated with lower urinary tract symptoms (LUTS). Patients frequently report troublesome nocturia, urinary obstruction and weak urinary stream, and increased frequency – all of which can substantially reduce the quality of life, impair mental health, and lead to increased healthcare costs.
This has driven our medical team's research toward finding safer, minimally invasive treatments that address the underlying mechanisms while preserving physiological function.
Conventional BPH Management
For many patients, medication represents the first line of treatment for BPH symptoms. Current pharmacological options include:
- Alpha-blockers, which work by relaxing the smooth muscle of the bladder neck and prostate, making urination easier
- 5-alpha reductase inhibitors, which shrink the prostate by the prevention of hormone changes that cause prostate growth
Medications often provide only modest symptom relief while potentially causing significant side effects, including sexual dysfunction, dizziness, and hypotension. Many patients also find the need for lifelong medication undesirable and experience diminishing effectiveness over time. When drugs prove ineffective, various surgical options are available:
- Open prostatectomy
- Transurethral resection of the prostate (TURP)
- Transurethral incision of the prostate (TUIP)
- GreenLight laser treatment
- Transperineal laser ablation
- HoLEP
- Aquablation
While common surgical procedures can effectively relieve symptoms, they carry substantial risks of complications including bleeding, retrograde ejaculation, urinary incontinence, and erectile dysfunction. Most surgical options also require general anesthesia, hospitalization, and extended recovery periods.
Minimally invasive alternatives have also emerged, such as prostatic urethral lift (UroLift), transurethral microwave therapy (TUMT), and the Rezum technique (water vapor ablation). Though less invasive, these approaches often provide less durable results than traditional surgery, with higher retreatment rates. Many are unsuitable for larger prostates (>80cc), and some deliver delayed symptom improvement.
These limitations in conventional treatments have forced our medical team to investigate more balanced therapeutic options that can provide effective symptom relief without compromising safety or quality of life. This extensive research has led us to identify prostatic artery embolization (PAE) as a promising non-pharmacological treatment for benign prostatic hyperplasia and a suitable alternative for many men.
For men suffering from challenging prostate adenoma symptoms who seek an alternative to medications or traditional surgery, PAE represents a revolutionary option with minimal risks and excellent outcomes.
Prostatic Artery Embolization: The Next Generation in BPH Treatment
Prostate artery embolization for benign prostatic hyperplasia represents a paradigm shift in disease management, offering superior clinical outcomes with minimal invasiveness compared to traditional approaches. Unlike medications that merely manage symptoms or surgeries that remove tissue, this groundbreaking procedure strategically reduces blood flow to the enlarged prostate, resulting in tissue shrinkage while preserving urinary and sexual function.
*Pisco JM et al Eur Radiol 2013;23(9):2561
How PAE Works
During the procedure stages, a prostate interventional radiology specialist accesses the arterial system through a small puncture in the femoral artery under local anesthesia. Using specialized imaging techniques, including digital subtraction angiography and cone-beam CT, the specialist navigates a microcatheter to the prostatic arteries that feed the enlarged prostate tissue. Small embolic particles (typically 100-500 μm) are then injected to block these arteries, reducing blood flow to the prostate.
PAE works through multiple synergistic mechanisms that make it particularly effective:
- Ischemic infarction leading to shrinkage of the enlarged prostate gland
- Relaxation of increased prostatic smooth muscle tone through α-adrenergic denervation (similar to the action of alpha-blockers)
- Nitric oxide-mediated relaxation of smooth muscle cells (analogous to phytotherapy)
- Interruption of the testosterone axis, providing androgen deprivation (similar to the progression-inhibition by 5α-reductase inhibitors)
- Ischemia-mediated apoptosis of prostate cells
This multifaceted approach allows PAE to provide both immediate symptomatic relief and sustainable reduction in prostate volume over time. Importantly, PAE can effectively reduce specific prostatic structures that cause obstruction, including the intravesical prostatic protrusion (IPP) and true middle lobe (TML), which are often major contributors to bladder outlet obstruction and storage symptoms that particularly bother patients.
Ideal Candidates for the Procedure
PAE is particularly well-suited for:
- Symptomatic patients with moderate to severe lower urinary tract symptoms (LUTS) as measured by the International Prostate Symptom Score (IPSS)
- Patients with impaired quality of life due to BPH symptoms
- Those who have not responded adequately to medical therapy for at least 6 months
- Patients who are not candidates for surgery or have refused a surgical intervention
- Men with prostatic volumes greater than 80cc that are too large for traditional TURP etc.
- Patients experiencing urinary retention medication needs
Research has identified several predictors of better clinical outcomes with PAE, including age less than 65 years, successful bilateral PAE (treating both sides of the prostate), lower baseline IPSS, and patients with urinary retention. Notably, patients with larger prostates (>80ml) often experience greater volume reduction (42.3% vs. 28.9%) and symptom improvement compared to those with smaller prostates.
*Data of Prof. Dr. med. Attila Kovács
The presence of a true middle lobe (TML) was previously considered a relative contraindication for PAE. Still, recent clinical studies have consistently demonstrated that PAE is effective as a procedure to alleviate problems caused by increased TML volume by approximately 32.1% when the TML is successfully embolized, with corresponding improvements in symptoms and urinary flow.
Key Advantages over Traditional Methods
Interventional radiology and prostate artery embolization offer several significant advantages over traditional BPH treatments:
- Minimally invasive procedure performed under local anesthesia
- No risk of TUR-related side effects such as retrograde ejaculation, incontinence, or sexual dysfunction
- Immediate effect, with LUTS improvement beginning after just 5-8 days
- The sustainable effect that continues to progress over the following 6 months
- Ability to reduce or eliminate medication use
- Particularly effective for storage symptoms (urgency and nocturia), which are often most bothersome to patients yet improve less with conventional surgery
- Exceptionally well-suited for patients with larger prostates (>80cc) who are not ideal candidates for TURP
- Very low retreatment rate of under 1% at 5 years
- Minimal side effects, with only about 8.5% of patients experiencing mild postembolization syndrome that can be effectively managed with non-steroidal anti-inflammatory drugs
As our research team has found, perhaps the most important advantage of PAE is its favorable side effect profile. The perioperative risks of bleeding and anesthesia complications, along with medium-term risks of urinary incontinence, effects on sexual function, and retrograde ejaculation associated with conventional treatments, are serious concerns for many patients. PAE's ability to avoid these complications leads to high patient satisfaction.
Expected Results and Recovery Timeline: Conventional vs Novel
Treatment approaches for BPH vary significantly in terms of their results, recovery timelines, and overall impact on patients' quality of life. Based on our research and clinical experience, we've found that PAE offers a compelling balance of effectiveness and minimal disruption to patients' lives.
| Treatment | Volume Reduction | Symptom Improvement (IPSS) | Recovery Time | Side Effects | Retreatment Rate (5 years) |
|---|---|---|---|---|---|
| Medications | Minimal or none | Variable, often modest | None (ongoing treatment) | Variable, including sexual dysfunction, dizziness | N/A (ongoing treatment) |
| TURP | 30-80% | 10-15 point reduction | 2-4 weeks | Moderate (retrograde ejaculation in 65-75%, bleeding, longer recovery) | 10.3-11.6% |
| Aquablation | 30-35% | 10-12 point reduction | 1-2 weeks | Mild (catheterization, bleeding) | About 1% |
| Rezum | 15-30% | 10-12 point reduction | 3-5 days | Mild (temporary urinary symptoms) | 4.4-7.5% |
| PAE | Up to 42% for prostates >80cc | 10-15 point reduction | 1-2 days | Minimal ( temporary localized discomfort) | Under 1% |
*Booking Health data
PAE demonstrates particularly impressive results in several key areas:
- Prostate volume reduction: studies show an average reduction of 25.8% overall, with even greater reductions (42.3%) in patients with larger prostates (>80cc)
- Intravesical prostatic protrusion (IPP): successfully reduced by 29.3% on average when the procedure is technically successful, addressing a major contributor to bladder outlet obstruction
- Symptom improvement: significant reductions in IPSS scores (10-15 points), particularly for storage symptoms like urgency and nocturia that patients find most bothersome
- Quality of life: substantial improvements in quality of life scores
- Urinary flow: increase in maximum flow rate by 4.5-6 ml/s, with greater improvements in patients with larger prostates
- Residual urine: reduction of 60-80 ml in post-void residual urine volume
Recovery after PAE is remarkably rapid compared to conventional treatments. Most patients experience only mild discomfort for 24-48 hours, which can be effectively managed with over-the-counter pain medications. Many patients can return to normal activities within 1-2 days, compared to weeks of recovery required after surgical interventions.
Importantly, while LUTS improvement begins within 5-8 days after PAE, benefits continue to progress over 6 months as the prostate gradually shrinks, providing sustainable long-term relief.
Accessing World-Class PAE Procedure with Booking Health
The limited availability of innovative treatments like prostatic artery embolization creates significant barriers for patients seeking alternatives to traditional BPH management. At Booking Health, we've made it our mission to bridge this gap by connecting patients with the specialized expertise needed for these cutting-edge interventions, simplifying access to international medical care.
The benign prostatic hyperplasia treatment market continues to evolve with innovative approaches like PAE gaining recognition worldwide. The procedure demands extensive experience in embolization therapy, detailed knowledge of complex prostatic vascular anatomy, and advanced imaging systems including cone-beam CT technology for safety and effectiveness. We provide comprehensive support for patients seeking PAE through a personalized approach that includes:
- Expert assessment of each case and connection to specialized facilities with experienced interventional specialists
- Development of individualized treatment programs at internationally recognized centers without foreign patient charges
- Complete medical and logistical coordination including documentation, appointments, and insurance coverage
- Travel support with transportation, accommodation, and interpreter services when needed
- Supportive therapy and ongoing care management including medication procurement and post-treatment communication with specialists
Prostate adenoma diagnosis and identification of appropriate treatment options require careful evaluation. By partnering with Booking Health, you gain access to centers of excellence and specialists with the necessary technical skills to perform PAE safely and effectively.
Our primary commitment is to your well-being and ensuring you receive the best prevention and treatment. By facilitating access to specialized interventions we hope to expand your BPH treatment possibilities and support your journey toward better prostate health and quality of life.
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Frequently Asked Questions of Our Patients
Send request for treatmentBenign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland affecting 45% of men over 45 and 80% of men over 70, causing urinary symptoms like frequent urination, difficulty starting urination, and incomplete bladder emptying.
The best treatment for benign prostatic hyperplasia depends on symptom severity and prostate size, ranging from medications like alpha-blockers to minimally invasive procedures such as prostatic artery embolization, which offers effective symptom relief with fewer side effects and faster recovery.
Several new benign prostatic hyperplasia treatment options include combination therapies and PDE5 inhibitors, though these medications typically provide modest symptom relief and may cause side effects, prompting many patients to seek more effective interventional alternatives.
No, benign prostatic hyperplasia does not increase prostate cancer risk. Despite both becoming more common with age, they are distinct conditions with different risk factors and cellular mechanisms.
When selecting a conventional or new treatment for benign prostatic hyperplasia, consider prostate size, signs and symptoms severity, comorbidities, preferences regarding side effects, recovery time, and impact on sexual function.
New treatments for benign prostatic hyperplasia offer advantages including reduced sexual dysfunction risk, shorter recovery periods, and fewer complications compared to traditional surgery options, while providing comparable symptom improvement without risks of bleeding, retrograde ejaculation, and incontinence.
The latest treatment for benign prostate enlargement includes prostatic artery embolization, Aquablation, Rezum water vapor therapy, UroLift, and laser therapies, all designed to reduce prostate volume or relieve obstruction with minimal side effects and recovery time.
Prostatic artery embolization is a nonsurgical procedure used to treat benign prostatic hyperplasia by blocking blood flow to the prostate, causing it to shrink. Ideal candidates include men with severe symptoms unresponsive to medication, those with prostates larger than 80cc, and patients prioritizing sexual function preservation.
Aquablation therapy is a new prostate adenoma treatment using a robotically-controlled waterjet guided by ultrasound imaging to remove prostate tissue precisely, offering reduced sexual side effects, shorter hospital stays, and treatment effectiveness regardless of prostate size.
Is laser therapy still considered a viable option for BPH, and how does it compare to newer treatments?
Laser therapy remains a viable benign prostatic hyperplasia alternative therapy offering reduced bleeding risk and shorter catheterization compared to traditional TURP, while newer options like PAE may better preserve sexual function and avoid general anesthesia for appropriate candidates.
Most benign prostatic hyperplasia nonsurgical treatment options carry fewer risks than traditional surgery, with PAE potentially causing temporary mild pain, aquablation requiring catheterization, and Rezum causing temporary symptom worsening.
Choose treatment abroad and you will for sure get the best results!
Authors:
This article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova, and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
Our editorial policy, which details our commitment to accuracy and transparency, is available here. Click this link to review our policies.
Sources:
National Institutes of Health (NIH)
Read:
HoLEP – painfree cure of benign prostatic hyperplasia (BPH)
Transurethral resection in treatment of benign prostatic hyperplasia
Aquablation in Germany: a promising prostate pathologies treatment
