Safety of Prostate Artery Embolization for BPH
Prostate artery embolization (PAE) is a safe treatment option for benign prostatic hyperplasia (BPH), with low rates of adverse events and complications, particularly for high-risk patients who are poor surgical candidates or refuse surgical therapy. 1, 2, 3, 4
Efficacy and Safety Profile
PAE has demonstrated effectiveness in treating lower urinary tract symptoms (LUTS), urinary retention, and hematuria caused by BPH with the following safety considerations:
- Long-term studies show PAE is safe with good outcomes over follow-up periods ranging from 3 to 96 months 5
- Clinical success rates are high, with only 1.9% early clinical failure and 23% symptom recurrence at a median follow-up of 72 months 5
- No reports of urinary incontinence or erectile dysfunction following the procedure 5
Common Side Effects vs. Complications
Most post-PAE complaints are considered side effects rather than complications:
- Common side effects include:
- Dysuria
- Urinary infection
- Hematuria
- Hematospermia
- Acute urinary retention
- Rectal bleeding 2
These side effects are typically mild and self-limiting, resulting from the inflammatory process in the prostate gland following embolization.
Potential Complications to Be Aware Of
While rare, more serious complications can occur:
Non-target embolization affecting:
- Bladder
- Rectum
- Penis
- Seminal vesicle
- Pelvic structures
- Bones
- Skin 2
Radiodermatitis may occur due to:
- Small vessel size
- Atherosclerosis
- Operator learning curve
- Long procedure or fluoroscopy times 2
Patient Selection and Evaluation
Proper patient selection is crucial for safety:
- Multidisciplinary evaluation by urologist and interventional radiologist is recommended 1
- Complete history to screen for non-prostate causes of LUTS
- Physical examination to evaluate candidacy for angiography
- Laboratory evaluation to ensure adequate coagulation and kidney function
- Imaging to determine prostate gland size 1
Comparison to Other Treatment Options
When considering treatment options for BPH:
- PAE is particularly valuable for patients with large prostate glands (≥80-120 mL) 1
- It offers a minimally invasive alternative to surgical options like TURP, which remains the benchmark for surgical therapies 6
- PAE has lower morbidity compared to traditional surgical approaches 2
Important Considerations for Clinical Practice
- Bilateral PAE is associated with better outcomes than unilateral PAE (21% vs 42% recurrence rate) 5
- Baseline PSA levels are inversely related to symptom recurrence 5
- Prostatic stents, by comparison, are associated with significant complications (encrustation, infection, chronic pain) and should only be considered in high-risk patients with urinary retention 6
PAE represents an important addition to the treatment armamentarium for BPH, offering a safe option particularly for those who are poor surgical candidates or have large prostate volumes.