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Overview

A majority of men over the age of 50 have one thing in common: an enlarged prostate. About half of men between 51 and 60 develop the condition, and that number steadily climbs in the decades that follow. Having an enlarged prostate (also called benign prostate hyperplasia) is not only uncomfortable, it can also slow down the flow of urine and affect ejaculation. Therefore, men with this condition eventually need treatment, although it is not in and of itself cancerous or life-threatening. 

If you are having symptoms and the diagnosis is enlarged prostate, you will want to talk to your urologist about the available treatment options, which range from surgery to medications. Add to that list a new procedure worth having a conversation about with your urologist about called prostate artery embolization (PAE).

At Yale Medicine, we offer a variety of treatment options for BPH, including embolization. While PAE recently received Food and Drug Administration approval, it is not yet widely available in the United States, and many urologists do not even know about it yet. Here at Yale we have one of the nation's top experts regularly performing this procedure.

What is prostate artery embolization (PAE)?

Prostate artery embolization (PAE) is an outpatient procedure performed by an interventional radiologist that involves the release of microscopic, plastic beads into the arteries that feed the prostate gland.  The beads travel to the patient’s prostatic arteries, and once there, they permanently block off the blood flow that’s causing the swelling in the prostate. While some enlarged prostate treatments negatively impact male sexual function, that’s not the case for those who opt for PAE, says Yale Medicine interventional radiologist Raj Ayyagari, MD. "Men can resume a normal, happy life again after embolization treatment," says Dr. Ayyagari.

What is prostate artery embolization used for?

PAE is for men who have enlarged prostates. While not life-threatening, an enlarged prostate can negatively impact a man’s day-to-day life. Men with this condition can encounter sexual and urinary issues.  Urine flow can become very slow and frequent.  Typical medical and surgical treatments for enlarged prostates can cause severe sexual dysfunction, and a condition called retrograde ejaculation.

What happens during the PAE procedure?

It works by placing a tiny catheter into the arteries that feed the prostate gland. A solution containing thousands of microscopic plastic beads is injected; these block the blood supply by shutting down blood flow to the gland. All of this is accomplished through a tiny quarter-inch hole in the skin. General anesthesia is not needed because the procedure is not all that painful. Most patients go home the same day with just a small bandage, requiring only a few days of recovery at home before returning to normal life. “Over time, the prostate gland is starved of its blood supply, and it shrivels up, like a grape shrinking into a raisin,” says Dr. Ayyagari. This allows the urethra to open up and urine to flow more normally.  Amazingly, shrinking the prostate does not have any negative impact on sexual function, and indeed a small number of patients actually experience an improvement in their sexual function after the procedure.

How long does the procedure take?

The outpatient procedure takes about two hours, so patients go home the same day. Recovery typically takes just a few days at home before patients can return to work and other routine activities.

Who is a candidate for PAE?

All men who’ve been diagnosed with BPH, who experience symptoms that are not controlled well by medications and who are not able to or do not want to undergo invasive surgical treatments, are candidates for PAE. Patients must have reasonable kidney function and not be allergic to the contrast dye used during the procedure.

What are the risks involved with PAE?

PAE has been shown to have fewer side effects than other widely used treatments for BPH such as transurethral resection of the prostate (TURP) surgery, which is associated with incontinence, impotence, retrograde ejaculation and erectile dysfunction issues in men.  When the procedure is performed by an experienced physician, the complication rate is extremely low and the procedure is incredibly safe and effective.  According to the World Journal of Urology, the following side effects can occur following PAE: transient blood in urine (hematuria), rectal bleeding, and acute urinary retention. In fact, with PAE, some men may actually experience improved sexual function following the procedure.

Do I need a referral for PAE?

You do not need a referral to have this procedure, but a full evaluation by a urologist is important.  So, we make sure you are also seen by one of our urologists before making a final decision about performing the procedure.

Is PAE covered by insurance?

Since the procedure is so new, some insurance companies may not offer coverage for PAE unless certain conditions are met, like having blood in the urine (hematuria). After discussing your medical history with you, we can check on coverage with your insurance company.

Why Yale Medicine?

Yale Medicine’s commitment to multidisciplinary care is a true differentiator that ensures every man gets the optimal treatment for his condition. Because we have a multidisciplinary team of experts, you can have a urologist evaluate your BPH symptoms and discuss all your treatment options with you, including PAE. We are one of the few medical institutions in the country regularly performing this procedure for our patients.