Thinking About the Prostatic Artery Embolization Procedure? Here's How Eligibility Is Determined

Prostatic artery embolization (PAE) offers a non-surgical solution for benign prostatic hyperplasia (BHP), otherwise referred to as an enlarged prostate. But how do you know if you're eligible for it? Continue reading to learn more.

What is PAE?

Prostate artery embolization is a minimally invasive treatment designed to shrink the prostate and relieve the troublesome urinary symptoms associated with BPH. During the procedure, tiny embolic beads are injected into the main arteries supplying blood to the gland, blocking the flow of blood and effectively starving the prostate. Following the procedure, the gland gradually shrinks, relieving pressure on the urethra caused by the enlarged prostate, improving  BPH symptoms and making you feel more comfortable.

Who should consider Prostatic Artery Embolization?

Let’s begin by explaining that just because you have BPH symptoms, it doesn’t mean you will need surgery or embolization. Many patients find that medication helps them live with BPH while small lifestyle habits, can make the condition more manageable. However, if your symptoms are disrupting your sleep and affecting your quality of life, your doctor may recommend alternative solutions, such as PAE.

Unfortunately, PAE isn’t for everyone. Doctors carefully select suitable candidates based on various criteria, including the severity of their symptoms, overall health, prostate size and personal preferences. Here are some of the factors that could make you a suitable candidate for PAE:

Moderate to severe BPH symptoms

Doctors typically recommend PAE for men experiencing significant urinary symptoms that are wearing them down and preventing them from doing the things they enjoy, like traveling or playing golf. These symptoms may include:

• Weak or interrupted urine flow
• Urgency or straining during urination
• Difficulty starting or stopping urination.
• A feeling of incomplete bladder emptying
• Frequent urination, especially at night (nocturia)

Inability to undergo surgery

Underlying health issues such as:

• Kidney disease
• Severe peripheral artery disease
• Bleeding disorders
• Cardiovascular disease
• Advanced age

may prevent some men from undergoing traditional surgery for BPH such as TURP. PAE is a safe procedure for these patients because it’s performed under local anesthesia and has a lower risk of complications.

Concern about sexual function

Unlike traditional surgeries for an enlarged prostate like TURP, which often causes erectile dysfunction or retrograde ejaculation, PAE has a low risk of sexual side effects. If you’re concerned about losing your sexual function, then PAE could be a better option.

Recurring urinary retention

If you regularly find difficulty in emptying your bladder, reducing the size of your prostate (PAE) and relieving the blockage preventing the bladder from emptying as it should, could help.

So now you know who should be considering PAE, who should seek alternative treatments?

When not to consider prostatic artery embolization

1. Kidney disease - The contrast dye used in PAE to map the arteries can be harmful for men with kidney disease and is therefore not recommended.
2. Bleeding disorders - If you have untreated bleeding disorders or major blood clotting, there is more risk of complications during PAE.
3. Severe urinary symptoms not caused by BPH – If bladder stones, bladder cancer or neurological disorders are deemed to be causing your urinary symptoms, PAE might not be the appropriate treatment.
4. Severe peripheral arterial disease (PAD) – It can be difficult to guide the catheter to the prostate arteries in patients suffering from PAD, which could raise the risk of complications.
5. Urinary tract infection – If you have a UTI (urinary tract infection) doctors will suggest postponing PAE treatment until the inflammation is resolved.

How is a person evaluated for the PAE procedure?

If you think you tick all the right boxes for prostate embolization, the first step is to schedule a consultation with a urologist or an interventional radiologist. They will carry out a thorough evaluation to determine whether the treatment is right for you and likely to be effective. Here’s what to expect:

Initial consultation:

During this appointment, your medical history, current symptoms and any previous treatments for BPH will be reviewed. Be open with your doctor and discuss the severity of your symptoms and how they affect your day-to-day living.  

Symptom scoring:

You may be asked to complete an IPSS Questionnaire or symptom score sheet which helps clinicians gauge the severity of urinary problems and monitor improvement over time.

Rectal examination:

The doctor will perform a digital rectum examination (DRE) to assess the shape and size of your prostate. This can also help identify any abnormalities that may require further investigations or an alternate choice of treatment.

Blood and urine tests:  

These can help rule out infections, cancer or other conditions that may be contributing to your symptoms.

Imaging and diagnostic tests:

Several diagnostic tests can be utilized to evaluate prostate size and urinary function.

• Ultrasound or MRI: Imaging helps assess the prostate’s size and rule out other conditions.
• Uroflowmetry: Measures the strength and speed of urine flow.
• Post-void residual measurement: Assesses how much urine remains in the bladder after urination.
• Angiographic assessment: An angiogram may be performed before the procedure to map the blood vessels supplying the prostate. This is vital since everyone’s arterial anatomy varies accessing and treating the correct vessels is critical to successful embolization.

Explore the benefits of PAE

For suitable candidates, the benefits of PAE are extremely advantageous when compared to more traditional surgeries and include:

• Outpatient procedure – PAE is typically performed in an outpatient setting, which means a patient can return home the same day, avoiding hospital stays and additional costs.
• Quick recovery – Most patients are advised to take a week away from work after which they can return to normal activities.
• Less swelling and pain – Most patients experience minimal swelling and discomfort after the procedure.
• Lower risk of side effects – PAE is less likely to impact sexual function and cause incontinence compared to traditional surgeries.
• No limitations on prostate size – Unlike some surgical options, PAE can treat prostates of all sizes and is particularly effective for larger prostates.
• Effective symptom relief – Numerous studies, including this one, conclude that PAE significantly improves the symptoms of BPH and quality of life.

Are you considering prostatic artery embolization?

If you’re one of the millions of men struggling with BPH symptoms, Mint STL offers PAE at their offices in St Louis, Missouri and Swansea, Illinois to help relieve your symptoms and improve your prostate health. Don’t suffer in silence. Call our experienced team at MINT or use our online booking system and take the first step toward getting your life back on track.