Relief from an enlarged prostate, without surgery
Prostate artery embolization (PAE) treats the urinary symptoms of an enlarged prostate through a pinhole in an artery, not through the urethra. There is no incision and no general anesthesia, and it does not affect erectile function.
Call to book: 737-241-2184 How PAE worksWhat is an enlarged prostate, and how does PAE help?
The prostate surrounds the urethra, the tube that carries urine out of the bladder. As men age, the prostate often grows. This is called benign prostatic hyperplasia, or BPH. It is not cancer, but an enlarged gland can squeeze the urethra and irritate the bladder, causing the symptoms many men know well.
PAE works on the gland's blood supply. Tiny particles are placed into the small arteries that feed the prostate, reducing its blood flow. Over the following weeks the gland softens and shrinks, taking pressure off the urethra.
Because nothing is passed through the urethra and no tissue is cut away, PAE avoids many of the side effects of traditional prostate surgery.3
Who is a good candidate?
The American Urological Association's 2026 guideline lists PAE as an option for selected men, performed by trained interventional radiologists after a proper evaluation.1 PAE is often a good fit if you are:
- A man with moderate to severe urinary symptoms from BPH that affect your daily life or sleep.2
- Someone with a larger prostate. The evidence is strongest for glands of about 50 mL (cc) or more. PAE can also treat very large prostates that are difficult to treat through the urethra.1,2
- On blood thinners or at higher risk of bleeding. The AUA guideline specifically names PAE as an option for these men.1
- Hoping to avoid surgery and protect erectile function.
- Living with a catheter because of urinary retention, as long as the bladder muscle still works.2
PAE may be less suitable for men with severe hardening of the pelvic arteries, a bladder that no longer contracts well, or symptoms caused by something other than the prostate. Your evaluation will check for these, and for prostate cancer, before treatment.
How we decide whether PAE is right for you
We work closely with Urology Austin, so you get a full urological evaluation and an interventional radiology opinion in one place.2
Consultation & symptom score
We review your history, medications and urinary symptoms, and you fill in the IPSS questionnaire, a standard score used to measure symptoms before and after treatment.
Tests
Urine and blood tests, a check of how well your bladder empties, and, when needed, a flow test. These rule out other causes of your symptoms.
Prostate imaging
Ultrasound, MRI or CT measures the size of your prostate and helps plan the procedure. MRI can also help look for signs of cancer.
How PAE compares with other options
There are many good treatments for BPH. The right one depends on your prostate size, your symptoms, your health and what matters most to you.
| Option | How it works | Things to know |
|---|---|---|
| Medication | Tablets relax the prostate or slowly shrink it | Usually the first step; must be taken long term and can cause dizziness or sexual side effects |
| Office-based procedures | Small implants or steam open the channel through the prostate | Done through the urethra; best suited to small or medium-sized glands |
| TURP or laser surgery | Prostate tissue is removed or vaporized through the urethra | The largest improvement in urine flow, but needs spinal or general anesthesia and carries a high rate of ejaculation problems4 |
| Prostate artery embolization | The prostate's blood supply is reduced through a pinhole in an artery | No incision, local anesthesia with light sedation, suited to large prostates, fewer side effects than TURP4 |
What happens during PAE
PAE is an outpatient procedure that usually takes one to two hours. You are awake but relaxed throughout.
Preparation
You receive light sedation and local anesthetic at the access site. No general anesthesia is needed.
A pinhole in the wrist or groin
A thin tube (catheter) is placed into an artery in your wrist or upper thigh through a tiny puncture. No incision is made.
Mapping the arteries
Using X-ray guidance and contrast dye, a microcatheter is steered into the small arteries that supply each side of the prostate. Detailed 3D imaging confirms the exact target and protects nearby organs.
Embolization
Microscopic particles are slowly injected until blood flow to the prostate is reduced. This is repeated on the other side.
Recovery
The catheter is removed and a small dressing applied. You rest for 30 to 60 minutes and go home the same day, usually without a urinary catheter.
Results
PAE has been studied in randomized trials, including against a sham (placebo) procedure and against TURP, the traditional surgery.
Greater symptom improvement on the IPSS score than a sham procedure at 6 months, in an 80-patient randomized trial. This confirms that the benefit is real, not a placebo effect.3
The side effects of TURP: 36 adverse events after PAE versus 70 after surgery. Symptom relief at 12 weeks was close (a 9.2-point vs 10.8-point gain on the IPSS score).4
Men still had clinical success more than 3 years after PAE (76%) in a series of 630 patients, and about 82% in the medium term.5
Most men notice improvement within a few weeks, with further gains over about three months. Because PAE shrinks the prostate rather than removing it, urine flow improves less than after TURP, and some men eventually need further treatment.2,4 Individual results vary, and no treatment can guarantee success.
Risks and side effects
Serious complications after PAE are uncommon. In the 630-patient series there were 2 major complications, both of which resolved fully.5 We discuss all risks with you in detail beforehand:
- Post-embolization symptoms for 1 to 3 days: mild fever, tiredness, pelvic ache, and burning or frequent urination. These are expected and managed with medication.2
- Temporary blood in the urine, semen or stool
- Bruising or tenderness at the wrist or groin puncture site
- A lower volume of ejaculate in some men
- Rarely, particles reaching nearby organs such as the bladder or rectum. Careful mapping keeps this risk low.4
- Reaction to contrast dye or sedation
- Symptoms returning over time, which may need repeat PAE or another treatment
Frequently asked questions
Is the procedure painful?
It is performed under local anesthesia with light sedation. Most patients feel only the small needle at the access site and some warmth from the contrast dye. A pelvic ache for a few days afterward is common.
Will I need a urinary catheter?
Most men do not need a catheter after PAE. If you already have one because of urinary retention, we aim to remove it in the weeks after treatment once your bladder empties well.
How soon will I feel better?
Many men notice a difference within one to two weeks, and improvement continues for about three months as the prostate shrinks.
When can I get back to normal activities?
Most men return to light activity within a day or two. Your physician will give you specific instructions about exercise, lifting and sexual activity.
Will PAE affect my sex life?
PAE does not affect erectile function. Some men notice less ejaculate, but ejaculation problems are less common than after surgery such as TURP.4
Can I stop my prostate medication afterward?
Many men are able to reduce or stop their BPH medications after PAE. Please don't stop any medication until your doctor tells you to.
Is it covered by insurance?
Coverage varies by policy. We will navigate out-of-pocket costs with you. Call us at 737-241-2184 with questions.
Find out whether PAE is right for you
If urinary symptoms are affecting your sleep or daily life, or medication hasn't helped enough, an evaluation can show whether prostate artery embolization is a good option.
Call 737-241-2184 to scheduleReferences
- Goueli R, Badlani GH, Welliver C, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline (2026). Part III: procedural/surgical management. J Urol. 2026. doi:10.1097/JU.0000000000005099
- Mouli S, Dolmatch BL, Gunn AJ, et al. Society of Interventional Radiology (SIR) 2026 practice guidance document for prostatic artery embolization. J Vasc Interv Radiol. 2026. doi:10.1016/j.jvir.2026.108771
- Pisco JM, Bilhim T, Costa NV, et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol. 2020;77(3):354–362.
- Abt D, Hechelhammer L, Müllhaupt G, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338. doi:10.1136/bmj.k2338
- Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27(8):1115–1122. PMID 27321890
- Marzano L, Thiounn N, Pereira H, et al. Prostatic artery embolization allows to maintain full sexual activity in patients suffering from bothersome lower urinary tract symptoms related to benign prostatic hyperplasia. Cardiovasc Intervent Radiol. 2020;43(8):1202–1207. doi:10.1007/s00270-020-02520-7
This page provides general information and does not replace a personal medical consultation. Study results describe groups of patients and cannot predict the outcome for an individual. Urology Austin and IR Centers · 8701 N. Mopac, Suite 100, Austin, Texas 78759 · 737-241-2184