Modern minimally invasive procedures like prostate artery embolization (PAE) are gaining popularity among medical professionals and patients but unfortunately, they’re not for everyone. This post answers the question “Who is not a candidate for prostate artery embolization?” and explores the factors that might lead to exclusion.
PAE works by blocking blood flow to parts of the prostate and shrinking it to relieve symptoms like frequent or weak urination. Performed as an outpatient procedure, recovery only takes a few days and complications are rare.
However, as mentioned above, not everyone is a candidate for PAE. Certain medical conditions, anatomical factors and even patient expectations may make PAE a less viable option.
Let’s look at exclusion criteria that are considered during the initial consultation before offering a patient PAE.
PAE involves injecting small particles into the blood vessels of the prostate through a catheter, reducing blood flow and causing the prostate to shrink. However, in patients with severe vascular disease or atherosclerosis—where arteries are hardened, narrowed, or blocked—accessing the prostate’s blood vessels may be challenging or even impossible. This can prevent the catheter from reaching the prostate, making the procedure unfeasible.
Alternative options: Medication or surgical options like transurethral resection of the prostate (TURP) may be more appropriate.
Although there isn’t a strict prostate volume requirement for PAE, it is generally recommended that the prostate volume be over 40-50 mL. Patients with a smaller prostate volume may not be considered suitable candidates. On the contrary, a person with a significantly enlarged prostate may only see limited benefits since the procedure may not shrink the prostate sufficiently to make any notable difference. Ultimately, deciding who is not a candidate for prostate artery embolization rests with the interventional radiologist carrying out the procedure.
Alternative options: Surgical interventions like HoLEP (holmium laser enucleation of the prostate) or TURP may be more effective for patients with a substantially enlarged prostate.
Patients are generally advised to avoid elective procedures if they have an active infection, particularly a urinary tract infection. Introducing instruments or foreign particles into the vascular system when there’s an existing infection could lead to sepsis or other severe complications.
Alternative option: It’s advised to undergo a course of antibiotics to clear the infection before considering PAE or any other prostate procedure.
During the PAE procedure, and under X-ray guidance, contrast dye is injected into the arteries to ensure the interventional radiologist is in the right place before injecting particles into the prostate arteries. When done, dye is used on both sides of the prostate to ensure they are blocked. Patients with allergies to contrast dye could face the risk of a severe allergic reaction.
Alternative options: Some patients may undergo desensitization treatment or be given alternative imaging techniques, but for others, avoiding contrast is essential, making PAE infeasible.
Patients with kidney disease or damage are not good candidates for PAE. Why? Chronic kidney disease is a known complication of benign prostatic hypertension (BPH). While PAE effectively treats lower tract urinary symptoms and relieves urinary obstruction, it requires angiography, typically with contrast dye, which is contraindicated in patients with kidney disease. While there are examples of carbon dioxide angiography in a kidney disease patient undergoing PAE, this option is not widely available.
Alternative options: TURP is a safer procedure for high-risk patients such as those with kidney disease.
Not all urinary symptoms in men are caused by BPH. Other issues, such as bladder cancer, bladder stones, or neurological conditions affecting bladder control, may cause similar symptoms. In such cases, PAE may not be beneficial because it doesn’t address non-prostate-related causes of urinary issues.
Alternative options: A comprehensive evaluation with imaging and urological testing can help determine the exact cause of symptoms and whether PAE is appropriate.
In some cases, urinary symptoms associated with BPH aren’t limited to prostate growth and may be due to bladder dysfunction or weakness. If bladder weakness is the primary cause of the urinary symptoms shrinking the prostate may not do much to alleviate the symptoms.
Alternative options: A comprehensive evaluation with imaging and urological testing can help determine the exact cause of symptoms and whether PAE is appropriate.
It’s important to understand that PAE is not a cure and symptoms may recur in some patients in the future. For optimal results, it’s vital to follow post-procedure instructions and attend follow-ups.
Alternative options: A detailed consultation and education from a healthcare provider will help set realistic expectations and ensure PAE aligns with the patient’s goals
People with certain high-medical conditions such as severe heart disease, uncontrolled hypertension and clotting disorders could face higher risks during an elective procedure such as PAE. Their medical history and risk profile should be carefully considered before undertaking any intervention requiring vascular access.
Alternative options: To lower the risk of complications, people should work with their doctor to get these conditions under control before considering PAE.
Now we know who is not a candidate for prostate artery embolization, the truth is that Prostate Artery Embolization is an effective option for many men with an enlarged prostate. However, conditions like severe vascular disease, very large prostates, or prostate cancer may make other treatments more appropriate. A thorough evaluation by a healthcare provider is essential to determine the best approach for each individual.
If you're interested in learning more about PAE and whether it’s right for you, contact MINT STL for a consultation with our expert interventional radiologists.
