Can Prostate Artery Embolization Be Repeated? What You Need to Know

If you’re considering prostate artery embolization (PAE) to relieve the troublesome urinary symptoms of an enlarged prostate, medically referred to as benign prostatic hyperplasia (BPH), one question that may be running through your head is  “Can prostate artery embolization be repeated if symptoms return?"

The simple answer is: Yes, it can, but there are several factors to consider. In this article, we’ll discuss when a repeat PAE might be necessary, its safety, and effectiveness, and what to expect if you’re considering undergoing the procedure again. But first, let’s discuss what PAE is.

Understanding prostate artery embolization

Performed by an Interventional Radiologist, PAE is a minimally invasive procedure generally conducted on an outpatient basis. It aims to shrink the enlarged prostate by blocking the blood supply in the arteries providing the gland with the nutrients it needs for growth. By doing so,  the prostate gradually decreases in size, taking the pressure off the urethra and gall bladder, and in most cases alleviating urinary symptoms associated with BPH such as:

• Weak or interrupted urine flow
• Urgency to urinate
• Difficulty starting urination
• Frequent urination, especially at night

PAE has a lower risk of complications compared to traditional surgeries like TURP, for the simple fact there is no need for general anesthesia or tissue removal.

So, why might a second PAE be necessary?

While several studies have reported long-term PAE outcomes in the majority of patients, they have also shown a 20% occurrence rate within 5 years and 30 to 60% recurrence within 10 years. The reasons for this could be:

1. Incomplete initial embolization: In some cases, only partial symptom relief is achieved because not all the arteries supplying the prostate were fully embolized.

2. Prostate regrowth: The symptoms may return due to natural glandular regrowth over time, hormonal changes or other factors.

So now you have an understanding of why a repeat PAE might be necessary, you may be wondering about its safety.

Is it safe to repeat prostate artery embolization?

Studies presented in the Journal of Vascular and Interventional Radiology (JVIR) have demonstrated the safety of repeat prostatic artery embolization to relieve lower urinary tract symptoms and acute urinary retention caused by BPH.

Furthermore, complications for a second PAE remain the same as for the initial procedure with the majority of side effects being mild and temporary such as slight discomfort and minor pain.

However, the JVIR  has concluded that repeat PAE has a limited impact on those patients who failed to respond to the initial PAE procedure. In such cases, it would be necessary to consider alternative treatment options which the patient can discuss with their healthcare provider.

Hopefully, this answered your initial question “Can prostate artery embolization be repeated?”  So now let’s discuss what ‘s involved in a second PAE.

What to expect during a repeat PAE

If you’re considering a repeat PAE, here’s what the process typically looks like:

1. Consultation and evaluation: You will need to visit your interventional radiologist to review your medical history once more and to undergo an imaging test such as an MIR or CT angiography, to determine whether repeat PAE is your best option.
2. The procedure: Just as for your first PAE, a small catheter will be inserted into an artery, either into your wrist or groin area )depending on your anatomy). With the aid of imaging, they will use small embolic particles as before to block the blood flow to the prostate.
3. Recovery: You should be able to return home the same day and feel fully recovered within a few days to a week and able to return to normal activities.

How effective is a second PAE?

Many patients report symptom improvement similar to or even better than their initial procedure. The key to success often lies in accurate imaging and targeting of all arteries that supply the prostate.

Factors that influence success include:

• Experience of the Interventional Radiologist: Choosing an experienced specialist significantly improves outcomes.
• Patient Health: Factors like prostate size, overall health, and the presence of other medical conditions can affect results.

Ultimately, carefully considered patient selection is key to the effectiveness of a repeat PAE.

Are there any risks with a repeat PAE?

Like any medical procedure, and PAE is no exception, there are potential risks which include:

• Temporary worsening of urinary symptoms such as burning and urgency
• Bleeding or bruising at the catheter insertion site
• Infection (rare)
• Accidental damage to other organs (This is minimized with advanced imaging techniques)

These risks are the same as for an initial PAE procedure and any side effects are usually mild and subside within a few days.

When to consider a second PAE

You should get in touch with your healthcare provider if you experience:

• Return of urinary symptoms after initial improvement
• Incomplete relief from the first PAE
• Worsening of symptoms over time

Early evaluation can help determine whether a repeat PAE or an alternative treatment is the best option for you.

Final thoughts

While prostate artery embolization can be repeated it’s generally not recommended if the patient fails to see an improvement in their symptoms, the first time round.

Get in touch with MINT STL

If your BPH symptoms have recurred following PAE, Mint STL is here to help. Our experienced interventional radiologists specialize in PAE and can assess whether a repeat procedure is right for you. Contact us today to schedule a consultation.