Prostate artery embolization (PAE) is a nonsurgical, leading-edge treatment for enlarged prostate that preserves much of the prostate, and has a quick recovery period. Greater than 90% of patients see significant improvement in the symptoms of enlarged prostate such as incontinence and the frequent urge to urinate.
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Enlarged prostate, also called benign hypertrophy or BPH, causes bothersome urinary symptoms due to the overgrowth of the prostate gland. As men age, the prostate gland continues to grow, sometimes to the extent that it squeezes the ureter, making urination difficult. During PAE, microspheres are released from a catheter inserted into the prostate artery. This cuts off the blood supply to some of the prostate gland and causes it to shrink. By undergoing this nonsurgical PAE procedure, men can be relieved of BPH symptoms.
In PAE, the interventional radiologist uses arteriogram and fluoroscopic techniques to visualize blood vessels. The images can be viewed in real time making the procedure fast and effective.
PAE is recommended for men with symptomatic enlarged prostate, or benign prostatic hypertrophy (BPH). Symptoms of BPH can include:
- Urinary urgency – feeling like you must urinate frequently
- Need to urinate multiple times during the night
- Dribbling at the end of urination
- Urinary hesitancy – difficulty starting urine flow
- Painful urination
- Urinary frequency producing a small amount urine each time
- Not being able to urinate at all due to obstruction
When you visit the ARA interventional clinic, you will be asked to fill out a short questionnaire about your symptoms, give a health history, and get a physical examination.
You can make steps toward treatment right now by getting in touch with our interventional coordinators at the contacts below. They will discuss candidacy for prostate artery embolization (PAE) with you. After this, you will meet with the interventional radiologist who will discuss your treatment options and pre-procedure tests. Patients will also need a referral to a urologist if they do not currently have one.
Prior to having prostate artery embolization, you may have some pre- and post-procedure evaluation tests, such as:
- Digital rectal exam
- Prostate-specific antigen (PSA) blood test to screen for prostate cancer
- CT study of the pelvis or other imaging
- Ultrasound after the bladder is emptied
- PAE is a nonsurgical procedure that can relieve the symptoms of BPH in greater than 90% of patients.
- PAE can allow men with BPH to avoid taking medications or needing more invasive procedures for treatment.
- Compared to other treatments, PAE has a lower risk of urinary incontinence and sexual side effects.
- If symptoms return, it is often possible to repeat the PAE procedure.
- The procedure is fast, safe, and only “twilight” sedation is used, not general anesthesia. Patients usually can return home the same day.
- While extremely rare, there is a risk of allergic reaction to contrast material containing iodine. ARA radiologists are well prepared in the event of such a reaction. If you have had an allergic reaction to contrast material in the past, your radiologist may recommend that you take medication for 24 hours before the procedure to reduce risk.
- During the procedure a small incision must be made in the skin for doctors to access an artery. Also, a catheter will be placed into the artery. Complications may include bruising, bleeding, hematoma, blood vessel damage and infection. In rare cases, surgical repair may be required. Your radiologists and technologists are trained to minimize the risk of complication.
- Rarely, devices used in PAE may malfunction and cause problems.
- Patients may experience “post-PAE syndrome” after the procedure. Symptoms can include nausea, vomiting, fever, pelvic pain, and painful or frequent urination. These symptoms typically disappear after a few days. Other side effects may include blood in the urine, semen, or stool, and bladder spasms.
- Prostate artery embolization is typically done in an ARA imaging center, hospital or medical center.
- You may be asked to remove all metal and jewelry, and you will be asked to change into a gown.
- You will be placed on an exam table, and you may be connected to devices that monitor your blood pressure, heart rate, and blood oxygen level.
- An intravenous (IV) line will be placed in a small vein of your hand or arm. You may be given a mild sedative similar to the “twilight” medication used in a colonoscopy.
- The skin over the blood vessel access site (usually the femoral artery in the groin) will be sterilized and covered with a sterile drape. You will be given an injection of local anesthetic. A small incision will be made at the site.
- A catheter will be inserted into the access site and guided through the vascular system to the prostate artery. Contrast will be injected to make your blood vessels visible by X-ray. A fluoroscope will take pictures which can be viewed in real time on a monitor by the interventional radiologist as they perform the procedure.
- Once the catheter reaches the area to be treated, microspheres are released from the catheter tip to block some of the arteries feeding the prostate.
- More images may be taken to make sure the embolization was completed effectively.
- When the procedure is finished, the catheter is removed, and pressure applied to the incision site.
- Most patients are discharged about 3 hours after completing the procedure, but it may sometimes be necessary to stay overnight. You should plan to rest in bed for 6-8 hours after the procedure.
- Wear comfortable, loose fitting clothing. You may want to leave all jewelry, piercings and any other metal objects at home.
- You will be asked not to eat or drink anything for up to 8 hours before the procedure. Ask your doctor for specific directions about your daily medications especially if you take any diabetes medication (insulin, etc.), blood thinners (aspirin, coumadin, warfarin, Plavix, etc.) or NSAIDs (ibuprofen, naproxen, etc.).
- Be sure to tell your radiologist about any illness or allergies you may have. Also, provide a list of your current medications.
- Since you will be sedated, please plan to bring a friend or relative to drive you home. You will be kept for observation at the facility until you are cleared to leave and should not plan to drive for 24 hours following the exam.
Each plan is different, so check with your provider. Generally, insurance will pay for PAE if it covers prostate surgery, but this is not always the case. After your consultation, if you require precertification from your insurance provider, ARA can assist you.