Prostate artery embolization (PAE) is an image-guided procedure for men whose enlarged prostate makes urination difficult. A thin catheter is passed from an artery in the wrist or groin to the small arteries feeding the prostate, which are then blocked. With less blood flow, the prostate shrinks over the following months and urinary symptoms ease. In a sham-controlled trial in Portugal, the prostate symptom score (IPSS) fell by an average of 17.1 points after six months.
This guide draws on guidance from the UK National Institute for Health and Care Excellence (NICE), patient information from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and University College London Hospitals (UCLH), and randomized trials and large registries from Europe. It covers who is suitable, the procedure, recovery time, side effects and availability abroad.
Treatment status · PAE treats benign prostatic hyperplasia (BPH), which is not cancer. The US Food and Drug Administration (FDA) authorized embolic microspheres for PAE in 2017, and NICE concluded in 2018 that the evidence on safety and efficacy is adequate. All figures below come from studies of real patients and hospital patient guides. This article is general information, not a treatment recommendation.
Three paths for treating an enlarged prostate
The prostate sits just below the bladder and wraps around the urethra. As it grows with age, it can squeeze the urethra, weakening the urine stream, waking men several times a night and leaving a feeling that the bladder is not empty. This condition is called benign prostatic hyperplasia and is different from prostate cancer.
Treatment usually begins with medication. When medicines are not enough, doctors consider transurethral resection of the prostate (TURP) or laser surgery, in which tissue is removed through the urethra. PAE is becoming a third option between these two steps, treating the prostate from inside the blood vessels instead of through surgery.
NICE recommends that patients be selected jointly by a urologist and an interventional radiologist, and that the procedure be done by an interventional radiologist with specific training in PAE. An overview of image-guided treatments is on our IVR (interventional radiology) page.
Why blocking the arteries shrinks the prostate
The prostate receives blood through thin branches arising from the pelvic arteries on each side. The doctor steers a catheter into these branches and releases tiny round particles (microspheres) to block them. With less blood supply, the enlarged tissue gradually shrinks and the pressure on the urethra eases.
The same principle is used for uterine fibroids, described in our uterine artery embolization guide and TAE guide. Because the prostate is left in place rather than cut away, recovery is quick and ejaculation is more likely to be preserved.
| Item | Prostate artery embolization (PAE) | Transurethral resection (TURP) |
|---|---|---|
| Method | Particles reduce blood flow inside the arteries | Tissue is removed through the urethra |
| Anesthesia | Usually local | Spinal or general |
| Hospital stay (Swiss trial) | Mean 2.2 days | Mean 4.2 days |
| Treatment-related adverse events | 36 | 70 |
| Change in ejaculation | 14 of 25 (56%) | 21 of 25 (84%) |
| Speed of improvement | Gradual, from 2 to 3 weeks | Relatively soon after surgery |
Based on Abt D, et al. BMJ 2018;361:k2338 (randomized trial of 103 men at St Gallen Cantonal Hospital, Switzerland) and CIRSE patient information.
Who receives PAE
CIRSE describes PAE for men with BPH whose frequent urination or night-time waking affects their quality of life. Situations often considered in practice include:
- Symptoms not controlled by medication: the 80 men in the Portuguese trial were aged 45 or older and had not responded to medical treatment.
- A very large prostate: UCLH states that PAE is the standard treatment it offers for prostates larger than 150 ml. In the Lisbon series, 210 men with prostates over 100 ml had a short-term cumulative success rate of 84%.
- A urinary catheter because of retention: in the Lisbon series, 106 of 112 men with acute urinary retention (94.6%) had their catheter removed between 2 days and 3 months after PAE.
- Surgery or general anesthesia is a concern: because PAE uses local anesthesia, it is also considered for older men and those with other conditions.
Severe hardening of the arteries can make it hard to reach the prostate arteries. The Lisbon team noted that advanced atherosclerosis linked to smoking or diabetes may make PAE unsuitable, so CT or MRI is used first to map the vessels and measure the prostate. Local treatment of prostate cancer is a different field, covered in TULSA ultrasound ablation for prostate cancer.
The procedure, from preparation to going home
According to UCLH, patients first see a urologist and a radiologist, then have a nurse-led assessment with blood tests (PSA, kidney function, clotting), a urine test and an ECG. If you take blood thinners such as warfarin, the team will plan when to stop them. Tell staff about any reaction to contrast dye.
| Item | UCLH (UK) | CIRSE (Europe) |
|---|---|---|
| Anesthesia | Usually local, sedation if needed | Local |
| Fasting | No food for 6 hours, clear fluids until 2 hours before | 6 to 8 hours |
| Access site | Wrist or groin | Groin or wrist |
| Procedure time | Usually 2 to 3 hours | Usually 1 to 2 hours |
| Rest afterwards | About 2 hours (wrist), 4 to 6 hours (groin) | Not specified |
| Antibiotics | Taken for 5 to 7 days | Given to prevent infection |
Based on UCLH and CIRSE patient information (Spanish edition). Follow the instructions from your own hospital.
- During the procedure: you lie on the X-ray table and receive local anesthetic at the puncture site. Using live X-ray, the doctor guides the catheter to the prostate arteries and injects contrast to map them and check for branches to nearby organs. Particles are then released to block the arteries on both sides, usually through a single puncture.
- Going home: once you have passed urine, you go home with an escort and rest for the day. Normal activities can usually resume the next day. If sedation was used, someone should stay with you overnight.
Recovery time and side effects
CIRSE explains that relief is not immediate: symptoms improve gradually from about 2 to 3 weeks, because the prostate takes time to shrink. Most short-term discomfort settles on its own.
| Symptom | How common / how long | Management |
|---|---|---|
| Pelvic pain | Common, usually 7 to 14 days and easing daily | Oral painkillers |
| Burning or urgency when passing urine | First 3 to 5 days | Fluids, medication if needed |
| Blood in urine or semen | Short-lived, usually a few days | Report if it persists |
| Bruise at the puncture site | Some patients, settles over 2 to 3 weeks | Call at once if swelling pulsates |
| Post-embolization syndrome (pain, fever, nausea) | Some patients | Painkillers and fever medicine |
| Urinary infection | Occasional | Preventive antibiotics |
| Particles reaching nearby organs | Very rare | 2 of 216 in UK-ROPE, self-limiting |
UCLH and CIRSE patient information; UK-ROPE study (BJU International 2018).
UCLH asks patients to call straight away if they cannot pass urine and have lower abdominal discomfort, develop fever or chills, or notice a painful, pulsating swelling in the groin. These problems are uncommon, and having the contact number ready brings peace of mind. The team checks in by phone at one day, one week and one month, and MRI and ultrasound within three months show how much the prostate has shrunk.
Results from clinical studies
Evidence on PAE has built up over more than a decade, mainly in Europe. A sham-controlled trial, a trial against surgery, a UK national registry and a 1,000-patient follow-up have all reported outcomes in real patients.
| Study | Patients | Main results |
|---|---|---|
| Sham-controlled randomized trial (Portugal, 2020) | 80 men not helped by medication | IPSS fell 17.1 points vs 5.03 with sham at 6 months; difference 13.2 |
| Randomized trial vs surgery (Switzerland, 2018) | 103 men, compared with TURP | IPSS fell 9.23 vs 10.77 points at 12 weeks; adverse events 36 vs 70; stay 2.2 vs 4.2 days |
| UK-ROPE registry (17 UK centers, 2018) | 305 men (216 PAE, 89 TURP) | Median IPSS improvement of 10 points at 12 months; 71% of PAE done as day cases or outpatients |
| Lisbon 1,000-patient follow-up (SIR 2017) | 1,000 men, mean age 67 | Cumulative success 89% short term, 82% medium term, 78% long term |
Pisco JM, et al. European Urology 2020 / Abt D, et al. BMJ 2018 / Ray AF, et al. BJU International 2018 / Pisco JM, SIR 2017 Annual Scientific Meeting.
In the Portuguese trial, the quality-of-life score improved by 3.48 points with PAE compared with 1.35 points with sham, and the investigators reported no harm to erectile function. In the Swiss trial, symptom improvement after PAE was close to that after TURP, with fewer complications and a shorter stay. Urine flow and prostate shrinkage were greater after surgery, so the authors suggested surgery first when obstruction has caused complications such as retention or bladder stones.
In UK-ROPE, 20% of PAE patients had further treatment during follow-up. If symptoms return, PAE can be repeated or surgery can follow, and because the prostate is left in place, later treatment remains possible.
Availability in Japan and abroad
| Region | Status | Basis |
|---|---|---|
| United Kingdom | NICE (2018) supports use with standard arrangements; offered at UCLH and other hospitals | NICE IPG611, UK-ROPE |
| United States | FDA authorized microspheres for PAE in 2017; offered by university interventional radiology teams | FDA de novo authorization (2017) |
| Portugal, Switzerland and other European countries | Offered at centers that led the major studies; CIRSE publishes patient information | Pisco 2020, Abt 2018, CIRSE |
| Japan | Availability and cost differ by hospital; check before your visit | Individual hospital information |
International patients are often not covered by the host country's public insurance, so confirm costs and schedules directly with the hospital.
When seeking PAE abroad, look first for a center where urologists and interventional radiologists assess patients together. Plan where the pre-procedure CT angiography or MRI will be done and whether you need to return for the three-month check.
Questions to ask your doctors
- Given my prostate size and symptoms, is embolization, surgery or medication the best fit?
- How many PAE procedures does this hospital perform each year?
- Will you go through the wrist or the groin, and how long must I rest afterwards?
- When should I expect to notice improvement, and when is the follow-up scan?
- If symptoms come back, what treatment can follow?
For more help preparing, see five questions to ask before an RFA consultation.
Frequently asked questions
Is prostate artery embolization painful?
It is done under local anesthesia, and CIRSE notes that pain afterwards is usually absent or mild. Some pelvic aching can occur; it is managed with oral painkillers and, according to UCLH, eases day by day over 7 to 14 days.
Do I need to stay in hospital, and how long is recovery?
In the UK-ROPE study, 71% of PAE patients were treated as day cases or outpatients. After about 2 hours of rest (wrist) or 4 to 6 hours (groin), you go home, and normal activities can resume the next day.
When does PAE start to work?
Because the prostate shrinks gradually, improvement begins from about 2 to 3 weeks. In the Portuguese trial, the symptom score had fallen by an average of 17.1 points at six months.
Does PAE affect sexual function or ejaculation?
The Portuguese investigators reported no harm to erectile function. In the Swiss trial, changes in ejaculation occurred in 56% after PAE and 84% after TURP. Individual results vary, so raise this at your consultation.
This article summarises overseas official sources and studies as general information and is not medical advice. Discuss treatment choices with a doctor who has examined you.
Sources (checked October 30, 2026)
- National Institute for Health and Care Excellence. Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia (IPG611). 2018.
- Pisco JM, et al. Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia. European Urology. 2020.
- Abt D, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338.
- Ray AF, et al. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: the UK-ROPE study. BJU International. 2018.
- Interventional News. 1,000-patient study indicates prostate artery embolization remains effective for years (Pisco JM, SIR 2017 Annual Scientific Meeting).
- University College London Hospitals NHS Foundation Trust. Prostate artery embolisation (PAE).
- CIRSE. Patient information: Prostatic artery embolisation (Spanish).
- Endovascular Today. Merit Medical Embosphere Microspheres Gain FDA Indication for Prostatic Artery Embolization. 2017.