What is the average reduction in prostate size after Prostate Artery Embolization (PAE)?

Prostate Size Reduction After Prostate Artery Embolization (PAE)

Prostate artery embolization (PAE) typically results in a 20-40% reduction in prostate volume, with the greatest shrinkage observed in the first 3-6 months after the procedure. The exact amount varies based on initial prostate size, technical success of the procedure, and individual patient factors.

Expected Prostate Volume Reduction

• PAE produces a mean prostate volume reduction of approximately 39% (±29%) according to long-term data from a 10-year experience study 1
• For extremely large prostates (>200 mL), PAE can achieve a significant reduction from a mean of 318.2 mL to 212.2 mL, representing approximately a 33% decrease in volume 2
• In prostates >90g, studies show a significant decrease from a mean of 135.1g before PAE to 91.9g at 3 months follow-up, representing about a 32% reduction 3
• Short and intermediate-term results indicate approximately 20% reduction in prostate volume at 1-month post-procedure, with sustained or improved reduction over time 4

Timing of Volume Reduction

• Initial prostate volume reduction begins within the first month after PAE 4
• Maximum volume reduction typically occurs within 3-6 months post-procedure 3
• Volume reduction is maintained in the intermediate term (up to 24 months) with continued clinical improvement 4
• Long-term data shows that volume reduction benefits can persist for years, though some patients (23%) may experience symptom recurrence at a median follow-up of 72 months 1

Factors Affecting Prostate Volume Reduction

• Bilateral vs. unilateral embolization: Bilateral PAE (performed in 94% of cases) shows better results with lower symptom recurrence (21%) compared to unilateral PAE (42% recurrence) 1
• Initial prostate size: Larger prostates may show greater absolute volume reduction, though percentage reduction remains similar 2, 3
• Technical success of the procedure: Complete bilateral embolization achieves better volume reduction than unilateral or incomplete procedures 1
• Baseline PSA levels: Higher baseline PSA is inversely related to symptom recurrence, suggesting better response to PAE 1

Comparison to Other Procedures

• At 3 months, Aquablation results in less prostate volume reduction (31%) compared to TURP (44%) (p=0.007) 5
• 5-alpha-reductase inhibitors (5-ARIs) like finasteride and dutasteride typically produce a 15-25% reduction in prostate size at six months, which is less than what is typically achieved with PAE 5

Clinical Implications of Prostate Reduction

• Significant improvement in International Prostate Symptom Score (IPSS) correlates with prostate volume reduction 3, 4
• Quality of life improvements are substantial following PAE, with mean quality-of-life score decreasing by approximately 2-4 points 3, 4
• Maximum urinary flow rate (Qmax) typically increases by 38% or more following successful PAE 4
• Post-void residual volume decreases by approximately 48% (±81%) following PAE 1

Important Considerations

• The American Urological Association (AUA) currently does not recommend PAE for the treatment of lower urinary tract symptoms/BPH outside the context of a clinical trial (Expert Opinion) 5
• The AUA cites concerns about the quality of available evidence, including lack of randomization in many studies, high levels of selection bias, and absence of standard inclusion/exclusion criteria 5
• Despite these limitations, PAE has shown promising results in reducing prostate volume and improving symptoms, particularly in patients with very large prostates 2, 3
• PAE appears to have a favorable safety profile with lower rates of complications compared to surgical alternatives like TURP (35.5% vs. 60.6%) 6