BENIGN prostatic hyperplasia (BPH) is a prevalent urological condition affecting men. While lifestyle changes and medications are often the first line of treatment, surgery becomes necessary for patients unresponsive to these interventions. Traditionally, transurethral resection of the prostate (TURP) has been the standard surgical therapy. However, newer minimally invasive techniques such as Urolift, Rezum, and prostatic artery embolisation (PAE) have shown potential for effective treatment with fewer complications.
PAE, a minimally invasive procedure, works by causing partial ischemic necrosis of the prostate gland, reducing its size and relieving symptoms. Research has consistently shown PAE to be a safe and effective alternative to TURP, with comparable symptom improvement but fewer adverse events. For patients unable or unwilling to undergo surgery, PAE provides a viable option for managing BPH.
Clinical studies have demonstrated the durability of PAE’s benefits over time. Improvements in International Prostate Symptom Scores and quality of life metrics are comparable to those achieved through TURP, with many patients experiencing significant symptom relief and a reduction in catheter dependency. Despite these benefits, a minority of patients may require additional interventions or continue using medications post-PAE.
The safety profile of PAE is noteworthy. Serious complications, such as non-target embolisation, are rare and often reversible. A recent international study reported technical success in the majority of cases, even among older patients with atheromatous arteries that complicate access to the prostatic artery.
While PAE is not without limitations, including variability in outcomes and the need for further studies to standardise techniques, it remains a promising therapy. Its recognition by organisations like the Society for Interventional Radiology underscores its growing acceptance.
As research continues, PAE is poised to become an integral part of BPH management, offering patients a safer, less invasive alternative to traditional surgical approaches.
Reference
Sapoval MR et al. Two-year outcomes of prostatic artery embolization for symptomatic benign prostatic hyperplasia: an international, multicenter, prospective study. Cardiovasc Intervent Radiol. 2024;47(11):1515-24.
