From the Guidelines
Prostate artery embolization (PAE) is a viable treatment option for benign prostatic hyperplasia (BPH) with a moderate quality of evidence supporting its benefits, including improved quality of life and reduced symptoms, as compared to transurethral resection of the prostate (TURP) 1. The benefits of PAE include a significant reduction in prostate volume, with a mean improvement in quality of life based on the IPSS-QoL through 12 months reported for 87% of the PAE participants 1. Some key advantages of PAE over TURP include:
- Lower rates of retrograde ejaculation, with 6% of PAE participants experiencing this side effect compared to 23% of TURP participants 1
- Fewer harms classified as Clavien-Dindo grade 2, with 26% of PAE participants experiencing these harms compared to 42% of TURP participants 1
- Reduced risk of blood transfusion and reoperation, with similar rates to TURP 1 However, PAE also carries some risks, including:
- Post-procedure pain and burning during urination
- Small risk of non-target embolization affecting the bladder or rectum
- Approximately 10-15% of patients may not experience significant symptom improvement
- Approximately 15-20% may need additional treatment within 5 years as BPH symptoms can recur Overall, PAE is a suitable option for men with BPH who wish to avoid the sexual side effects of traditional surgery or have very large prostates, with the most recent evidence supporting its use as a viable alternative to TURP 1.
From the Research
Risks and Benefits of Prostate Artery Embolization for BPH
- The procedure has shown promising results in reducing prostate size and improving symptoms of benign prostatic hyperplasia (BPH) 2, 3, 4.
- Prostatic artery embolization (PAE) may improve BPH symptoms and urodynamic measures, but the evidence is uncertain when compared to transurethral resection of the prostate (TURP) 5.
- PAE may result in fewer adverse events compared to TURP and open simple prostatectomy (OSP) 5.
- The cost-effectiveness of PAE is uncertain when compared to TURP, and PAE is unlikely to be cost-effective compared to OSP 5.
- Patients who have undergone PAE have reported improved quality of life and reduced symptoms of BPH 5, 4.
Potential Risks and Complications
- PAE is a minimally invasive procedure, but it still carries risks of adverse events, such as nontarget embolization and bleeding 6, 3.
- The procedure requires careful patient selection and meticulous embolization to optimize results and minimize complications 3.
- Longer-term comparative studies are needed to assess the durability and long-term adverse events of PAE 5.
Benefits and Advantages
- PAE may be considered as a preoperative approach for patients with large prostate volumes, making TURP more feasible 4.
- The procedure can be performed under local anesthesia, and patients can urinate spontaneously after removal of the urethral catheter 2.
- PAE has been shown to reduce prostate volume, improve urinary flow, and decrease postvoid residual urine volume 2, 4.