If you’ve been dealing with the constant disruptions of an enlarged prostate, you know how much it can impact your daily life. Waking up several times at night to use the bathroom, struggling with a weak urine stream, or feeling like you can’t fully empty your bladder are all common frustrations. These problems are often caused by a condition called benign prostatic hyperplasia, or BPH for short.
You may have heard about prostate artery embolization (PAE) as a way to shrink the prostate without surgery. But before moving forward, it’s important to know who is not a candidate for prostate artery embolization. This minimally invasive outpatient procedure has helped many men find lasting relief from urinary symptoms, but certain health factors, anatomical considerations, and aspects of your medical history may mean another approach would work better for you.
How Prostate Artery Embolization Works
PAE for enlarged prostate is a minimally invasive treatment option performed by an interventional radiologist. Using advanced imaging techniques, the doctor makes a tiny puncture in the groin or wrist to insert a small catheter into the prostate artery.
Microscopic particles are then delivered to block blood flow to the enlarged prostate tissue. With less blood supply, the prostate gland shrinks over time, relieving pressure on the bladder and easing urinary symptoms like:
- Frequent urination
- Weak urine stream difficulty
- Acute urinary retention
- BPH symptoms such as urgency or incomplete emptying
Most patients go home the same day, and recovery typically takes just a few weeks.
Who May Not Be a Candidate for PAE
While many patients benefit from PAE, there are situations where another treatment option may be better. You might not be a candidate if you have:
- Prostate cancer. PAE treats a non-cancerous enlargement of the prostate. If cancer is suspected or confirmed, your doctor will recommend oncologic evaluation and treatment.
- Severe arterial disease. Conditions such as significant atherosclerosis may make it difficult to access the blood vessels supplying the prostate. Clinical guidelines cite severe atherosclerosis as a common contraindication (AUA Journal, 2024), and the CIRSE Standards of Practice emphasize the prostate artery’s small size and anatomical variability, which can make access challenging in these cases (CIRSE Standards of Practice).
- Extremely large prostate gland. While PAE can treat large prostates, some cases of extreme enlargement may require surgical treatments for faster or more complete relief.
- Active urinary tract infection. Infections must be treated before any prostate artery embolization procedure to lower the risk of complications.
- Bladder dysfunction unrelated to BPH. If your urinary problems stem from nerve or bladder muscle disorders rather than an enlarged prostate, PAE may not improve symptoms.
- Allergy to contrast dye. PAE uses imaging contrast, so a history of severe allergic reactions may require alternative approaches.
Your medical history and overall health will guide whether you are a safe candidate.
Comparing PAE to Traditional BPH Treatments
Before PAE became widely available, men with severe BPH symptoms often faced traditional surgery such as transurethral resection of the prostate (TURP) or open prostatectomy. While these procedures can provide symptom relief, they often require general anesthesia, a hospital stay, and longer recovery.
PAE offers:
- No cutting or removal of tissue
- Use of a mild sedative instead of general anesthesia
- Lower risk of sexual dysfunction or retrograde ejaculation (PMC, 2022, ICUrology, 2021)
- Minimally invasive approach with a smooth recovery
Still, some men benefit more from traditional procedures, especially those with certain anatomical challenges or prostate sizes that make PAE less effective (PMC, 2021).
The Role of Imaging and Access
For PAE to work, the interventional radiology team must be able to reach the prostate artery using a catheter. Advanced imaging helps map out the blood vessels and determine if there is a clear path for treatment.
If blood flow patterns are unusual, or if tiny particles cannot be safely delivered to the target area, your doctor may recommend other traditional BPH treatments.
Insurance Coverage and Medical Review
Most insurance companies now recognize prostatic artery embolization as a valid minimally invasive treatment for BPH. However, they often require:
- Documentation of BPH symptoms
- Proof of failed response to medications or other treatment options
- Imaging results showing prostate enlargement
Medicare and private insurers may also require that the procedure be performed by a board-certified interventional radiologist trained in PAE. Always confirm with your insurance company before scheduling.
The Importance of a Comprehensive Evaluation
Choosing the best treatment for prostate enlargement is not just about addressing urinary symptoms. A full evaluation includes:
- A review of your medical history
- Assessment of your current urine flow and bladder function
- Testing to rule out prostate cancer
- Imaging to examine blood supply to the prostate
This careful review helps determine whether you’ll respond well to PAE or whether another minimally invasive treatment or traditional surgery would give you better results.
How PAE Affects Sexual Function and Recovery
One reason many men seek PAE is its lower risk of sexual dysfunction compared to traditional BPH treatments. While any procedure can have side effects, PAE is less likely to cause retrograde ejaculation or erectile dysfunction.
Recovery is generally shorter than surgery, with most patients resuming normal activities within a few weeks. Mild discomfort or urinary symptoms can occur temporarily as the enlarged prostate gland shrinks.
When Another Approach May Be Better
If you are not a candidate for PAE, alternatives may include:
- Medication to relax the prostate or shrink enlarged prostate tissue
- TURP or laser-based surgical treatments
- UroLift or other minimally invasive devices that open the urinary channel
Each has its own benefits, risks, and impact on sexual function and long-term symptom relief.
Take the Next Step Toward Symptom Relief
If you’re dealing with frequent urination, a weak urine stream, or acute urinary retention, you should know all your options, including whether PAE is the right choice for you. Many men searching online for “prostate embolization nearby” or looking for “prostate artery embolization doctors near me” want an option that delivers lasting results without surgery.
Dr. Adam Gropper is a board-certified radiologist and fellowship-trained interventional radiologist who brings over 20 years of experience to prostate artery embolization. He performs PAE in Miami using advanced imaging and a patient-centered approach.
During your evaluation, you’ll learn whether PAE can give you the long-lasting symptom relief you want or whether another treatment might be more effective for your situation. Call (786) 500-5347 today to schedule a personalized consultation, or fill out our confidential online form.
While you wait for your consultation, download our FREE guide, 5 Reasons to Choose Prostate Artery Embolization, and learn how this outpatient procedure could ease symptoms and support your quality of life.
Prefer a more in-depth look? Join us for our FREE Webinar: Mastering Prostate Health: The PAE Breakthrough for Men. Check it out here to reserve your spot.
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Prostate Specialists of Miami
15400 Biscayne Boulevard #104
Aventura, FL 33160
(786) 500-5347
http://prostatespecialistmiami.com/
