What is Prostatic Artery Embolisation?
Prostatic Artery Embolisation (PAE) is an innovative, minimally invasive procedure used to help improve lower urinary tract symptoms (LUTS) caused by benign prostate hyperplasia (BPH) – a condition resulting in the enlargement of the prostate.
It is considered to be a safe and effective method of treating an enlarged prostate in Australia and has been shown to yield great results: over 90% of men gain symptomatic improvement (decreases in prostate volume and increases in urinary flow rates) following the procedure, and undergoing PAE doesn’t prevent you from undergoing other prostate reduction procedures later on.
This is a complex procedure that can only be performed by a specialist interventional radiologist with expertise in the area.
How is PAE Performed?
PAE is generally done under sedation and a local anaesthetic. This makes PAE a viable option for men with complex medical issues who can’t have the general anaesthetic required for more invasive treatments.
Following sedation, a tiny tube is inserted into the femoral artery via the groin area and guided into the prostate arteries using X-rays. This tube can also be inserted via the radial artery in the wrist, which allows for quicker mobilisation post-procedure and discharge from the hospital.
It is then used to deliver tiny particles which embolise (block) the arteries, reducing blood flow to the prostate and causing it to decrease in size in the days, weeks, and months following the procedure. You may feel some minor burning sensations during treatment, but this is normal and rarely too painful. The entire procedure generally lasts 2-3 hours.
Following the procedure, you will need to remain in the hospital for up to two hours for a radial procedure and six hours for a femoral procedure. There is no need to remain overnight, and (unlike with more invasive treatment options like TURP) there is only a 5% risk of needing a catheter post-procedure.
Below is a video from ask4pae.com explaining the procedure:
What are the Benefits of PAE?
There are a range of benefits associated with Prostatic Artery Embolisation.
Firstly, it has been proven to achieve results for around 90% of patients who undergo the procedure.
Secondly, since the procedure itself is not considered a ‘major’ surgery, patients can expect reduced post-procedural side effects. For most procedures done by an IR, we like to say you get improved ‘lifestyle outcomes’ - faster recovery, less painful recovery, shorter hospital stays, and avoiding major surgery.
Other benefits of PAE include:
- Minimally invasive procedure - it only requires a small incision in your wrist or groin.
- Typically performed as an outpatient procedure, meaning you won’t need to stay overnight
- When compared to other surgeries, such as TURP, PAE offers a shorter hospital stay and a faster recovery time
- Less likely to require urethral catheterization in comparison to surgery
- Relieves lower urinary tract symptoms (LUTS) such as feelings of urgency and frequency especially at night (nocturia), incomplete bladder emptying, weak urine stream, intermittency, and straining while urinating
- Comes with a lower risk of negative side effects, especially sexual or incontinence, when compared with other surgery options
- Overall significant improvement in quality of life
- Can be used without limits on prostate size, urethral narrowing, or bladder capacity
What are the Risks of PAE?
Just like with any medical procedure, PAE comes with a set of risks. It is considered a safe treatment option, but risks include:
- Haematoma – a small bruise may form at the needle’s insertion site. This is quite normal and nothing to be concerned about. It can be treated by painkillers and will generally clear up on its own.
- Pain – many patients experience some mild pain in the days following the procedure. This can usually be managed with over-the-counter painkillers and anti-inflammatory medication, but can occasionally become severe and warrant further intervention.
- Catheterisation – in about 2-5% of cases, the treatment may cause the prostate to swell as a response to the treatment and block urinary flow. If this happens, it may be necessary to insert a urinary catheter.
- Blood in the urine, semen, or stool – you may notice a small amount of blood in the days following your procedure. If your symptoms persist or bleeding becomes heavy, consult your doctor immediately.
- Bladder spasms – the bladder can contract involuntarily, which may cause an intense urge to urinate, bladder leakage, and pain.
- Infection – the prostate and needle insertion site may become infected if they are not adequately cared for in the following days.
- Post-PAE syndrome – this affects about 9% of men who undergo PAE. It is characterised by nausea/vomiting, perineal pain, and dysuria (painful or difficult urination)
During your consultation you’ll be walked through all the risks and given advice on how to minimise post-treatment negative outcomes.
What is Recovery Like?
Following your Prostatic Artery Embolisation, you will be given a prescription for antibiotics and advised to take painkillers and anti-inflammatory medication. You'll need to take a week of rest and avoid exercise, heavy lifting, and intercourse, and you may experience some tiredness and burning pain when passing urine in the next few days. These symptoms usually settle after a week or so.
Who Can Undergo PAE?
PAE offers a suitable alternative to the more traditional transurethral resection of the prostate (TURP), making it a viable solution for prostate reduction for:
- Men who take antiplatelets or blood thinners/anticoagulants, as the risk of bleeding is much less than in more invasive treatments. The procedure can also be performed without interrupting the anticoagulants (interrupting anticoagulants can increase the risk of stroke, making it a safer option)
- Men who, by virtue of other medical problems, are considered too high risk for general anaesthetic can undergo PAE as it is performed under a local anaesthetic instead
- Men with very large prostates, for whom surgical options may be less safe or effective. In fact, with PAE, the larger the gland, the more effective the treatment.
- Men with permanent urinary catheters who have been told that they don’t have another option – it is very common for men to be able to successfully remove their catheters following PAE
- Men who don’t want to undergo surgery and whose symptoms are poorly controlled on medication – PAE is a much less drastic procedure than traditional surgery, and many men who don’t feel comfortable going under the knife are more at ease with PAE compared to an alternative such as TURP.
However, PAE may not be suitable for men with urinary tract symptoms (who may have an enlarged prostate without it being the main cause of their symptoms), associated problems such as bladder stones, or predominately nighttime symptoms (nocturia). Men with ‘mild’ symptoms (as assessed at the time of consult) are sometimes considered to be best treated with medication, however, the presence of other factors, medical conditions, and side effects from medications can of course tilt this balance in favour of intervention.
How Much Does Prostatic Artery Embolisation Cost?
As with many procedures, it can be difficult to provide accurate estimates for what it will cost. Fortunately, Northern Beaches Interventional Radiology is part of 'gap cover' for all Health Funds, therefore you will have no out of pocket expenses if you have your procedure performed by us.
Click here to read The UK National Institute for Health and Care Excellence (NICE)’s announcement of updating its guidance to include PAE as a suitable treatment for BPH.
Click here to visit the website for Ask4PAE, an educational patient program dedicated to raising awareness about BPH and its treatment options.
Is PAE Right for Me?
Before you can undergo the PAE procedure, you will need to undergo a variety of imaging procedures which help to determine your suitability and detect any underlying issues you may have. The investigations you need will be discussed with your doctor during consultation, but may include:
- Renal tract/bladder ultrasound – these are used to assess the state of your prostate and may help identify any underlying issues.
- Urine flow study – this is used to calculate your flow speed, volume, and the time it takes for you to pass urine.
- Prostate-specific antigen (PSA) blood test – this is used to check for signs of prostate cancer
Should PAE be a suitable treatment option for your symptoms, further scans will generally be required. These include:
- CT angiogram – this is a specialised CT used to evaluate the blood vessels supplying the prostate
- Prostate MRI – this is done as a baseline to allow comparison after treatment as well as to exclude the possibility of any cancer in the prostate.
Other investigations and scans may also need to be conducted to rule out any signs of prostate cancer, as cancer will need to be dealt with in preference to benign prostate enlargement concerns.