Prostatic artery embolization

Prostatic artery embolization (PAE, or prostate artery embolisation) is a developing non-surgical technique for treatment of benign prostatic hypertrophy (BPH). Although there is increasing research on PAE, use of the technique remains at an incipient stage. Prostatic artery embolization (PAE, or prostate artery embolisation) is a developing non-surgical technique for treatment of benign prostatic hypertrophy (BPH). Although there is increasing research on PAE, use of the technique remains at an incipient stage. The procedure involves blocking the blood flow of small branches of the prostatic arteries using microparticles injected via a small catheter, to decrease the size of the prostate gland. It is a minimally invasive therapy which can be performed with local anesthesia, as an outpatient procedure. Men with an enlarged prostate may suffer from symptoms of lower urinary tract obstruction, such as sensation of incomplete urination, inability to urinate, weak urinary stream, or having to urinate frequently (often awakening from sleep). If the symptoms cause a significant disruption to quality of life, a man may undergo initial treatment by oral medication, such as alpha-1 receptor blockers, 5-alpha-reductase inhibitors, or phosphodiesterase-5 enzyme inhibitors. Those with severe/progressive symptoms or those who do not experience symptom relief from medication have traditionally been considered for surgical intervention, with transurethral resection of the prostate or TURP as the standard of care. However, there are problems with both medical and surgical treatments, including undesired side effects and variable effectiveness. For example, sexual dysfunction and orthostatic hypotension are side effects of 5-alpha-reductase inhibitors. Prostatic artery embolization is an emerging treatment alternative which avoids the risks of systemic medication and of surgery. The first report of selective prostatic artery embolization resulting in relief of prostate gland obstruction was published in 2000. Since then, prospective trials with small numbers of patients, up to approximately 200 patients/trial, have been carried out internationally. Results show that PAE decreases prostate gland size, prostate specific antigen level, peak urinary flow, post-void residual, and subject urinary symptoms.