A Look at Prostate Artery Embolization for BPH

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Doctors have long known that cutting off the blood supply from the arteries leading to a cancerous tumor or other abnormal tissue can cause it to shrink. This technique, called embolization, is also used to stop bleeding. Surgeons incidentally discovered that the technique could be used to offer BPH relief after a man with persistent blood in his urine was treated with prostate artery embolization (PAE) and experienced improved lower urinary tract symptoms. The serendipitous finding helped pave the way for the FDA’s 2017 approval of the device used to perform PAE to treat lower urinary tract symptoms related to BPH.

How it’s performed. PAE is performed with the patient under local anesthesia. The doctor, typically an interventional radiologist, inserts a slender tube (catheter) into a small incision in the groin. Using special X-ray guidance (arteriogram), the surgeon advances the catheter to the arteries that deliver blood to the prostate. Next, the surgeon injects tiny beads, or microspheres, through the catheter into the arteries to block blood flow to the prostate. This causes the prostate to shrink, and, in turn, leads to symptom improvement in a few days.

Recent findings. Researchers in Switzerland randomly assigned 103 men with BPH symptoms that did not respond to medical treatment to undergo PAE or transurethral resection of the prostate (TURP)—the gold standard treatment for BPH. The results, reported in 2018 in BMJ, showed that overall, symptoms improved in men who had PAE, though scores on a questionnaire that assesses symptom severity (International Prostate Symptom Scores, or IPSS) dropped slightly more in those who had TURP. In addition, PAE was less effective than TURP in improving urine flow.

Caveats. The American Urological Association (AUA) considers PAE to be experimental and inadequately tested. The current AUA guideline on the surgical management of BPH recommends that men undergo this procedure only if they are enrolled in a clinical trial.