What Is a PAE Procedure?
The PAE procedure, or Prostate Artery Embolization, is a minimally invasive outpatient treatment for BPH. At Medical Center Radiologists in Hampton Roads, VA, our fellowship-trained interventional radiologists perform the treatment using a small incision in either the right groin or left wrist. The approach allows the procedure to be completed without a large surgical incision and helps patients return to normal activities quickly.
The goal of the procedure is to reduce blood flow to the prostate. By limiting the nutrients delivered to prostate cells, the treatment causes some of those cells to die. Over time, the prostate decreases in size, creating more space around the urethra and improving the flow of urine.
Why Does an Enlarged Prostate Cause Urinary Symptoms?
The prostate surrounds the urethra, the channel that carries urine from the bladder. As the prostate grows, particularly in the transitional zone surrounding the urethra, it gradually narrows this channel. This narrowing makes it more difficult for urine to pass and contributes to many of the urinary symptoms associated with BPH.
The PAE procedure addresses this problem by reducing the size of the prostate rather than removing prostate tissue through traditional surgery. As the gland decreases in size, the urine channel has more room, which helps alleviate BPH symptoms.
How Does the PAE Procedure Shrink the Prostate?
During the procedure, our interventional radiologists use specially designed wires and catheters to reach the arteries supplying the prostate. Fluoroscopy and cone beam CT 3D reconstruction help guide the physician and confirm access to the prostatic arteries.
Once the arteries are reached, tiny microspheres measuring less than 1 millimeter are delivered into the vessels supplying the prostate. These particles block blood flow to the gland. With less blood supply, prostate cells begin to die and the gland gradually decreases in size.
What Happens During a PAE Procedure?
Before the PAE procedure, an IV is started and antibiotics are administered to help prevent infection. We also administer a one-time dose of IV steroids to reduce the inflammatory response. Conscious sedation, sometimes called twilight sleep, is provided while nursing personnel continuously monitor vital signs.
The procedure requires only a quarter-inch incision in the right groin or left wrist. A catheter is guided through the arterial system to the left and right prostatic arteries. After the microspheres are delivered, the catheter is removed and the small access site is treated. MCR typically doesn’t place a Foley catheter unless a patient already depends on one.
What Is Recovery Like After Treatment?
Following the PAE procedure, patients generally remain in the Interventional Radiology recovery area for approximately three hours before going home. We routinely prescribes oral antibiotics, a short steroid taper and high-dose NSAIDs for seven days to help prevent infection and reduce inflammation.
During the first three to five days, some patients experience increased urinary frequency, bladder spasms and pelvic discomfort. These symptoms are part of the early recovery period, and additional medications can be prescribed when needed.
When Does the Prostate Begin to Shrink?
The effects of the PAE procedure develop over time rather than immediately. The prostate generally begins decreasing in size approximately four to six weeks after treatment. Follow-up typically includes an ultrasound at three months and additional imaging, such as CT or prostate MRI, at six months.
The NIH reports an approximately 15% to 30% reduction in prostate size by three months, with reductions of up to 50% at 12 months.
What Are the Benefits of Treatment?
One benefit of the PAE procedure is its minimally invasive approach. Unlike traditional surgical treatments for benign prostatic hyperplasia, Prostate Artery Embolization uses a small arterial access site and doesn’t require removal of prostate tissue. Treatment hasn’t been associated with reports of urinary incontinence or sexual dysfunction.
Clinical outcomes include an 88% clinical success rate reported in peer-reviewed literature. A randomized clinical trial also found equivalent symptom improvement between Prostate Artery Embolization and TURP at six months, with similar results continuing through 12 and 24 months.
For men dealing with urinary symptoms related to an enlarged prostate, the PAE procedure provides a minimally invasive treatment option that focuses on reducing prostate size and improving the urinary channel. At Medical Center Radiologists in Hampton Roads, VA, our specialized interventional radiologists use advanced imaging and image-guided techniques to perform treatment for appropriately selected patients.