Enlarged Prostate Treatment Without Surgery: Is Prostate Artery Embolization Right for You?

The prostate is a gland about the size of a walnut that sits just below the bladder and wraps around the urethra, the tube that carries urine out of the body. In most men it grows slowly with age. As it enlarges, it can squeeze the urethra and make it harder for the bladder to empty.

The result is a familiar set of symptoms, often called lower urinary tract symptoms (LUTS):

• Getting up at night to urinate (nocturia)
• A weak or interrupted stream
• Hesitancy, or straining to start
• A feeling that the bladder has not fully emptied
• Urgency and frequent trips during the day
• Dribbling at the end

These symptoms can have other causes too, so a proper evaluation comes first. That usually includes a symptom questionnaire, a urine test, a PSA blood test, and imaging of the prostate. Blood in the urine, fever, or being unable to pass urine at all needs prompt medical attention.

BPH treatment is usually stepwise. It often begins with lifestyle changes such as drinking less in the evening and cutting back on caffeine and alcohol. Medication comes next: some drugs relax the muscle around the urethra, while others gradually shrink the prostate.

When medication is not enough, or its side effects are hard to live with, the traditional next step has been surgery, most commonly transurethral resection of the prostate (TURP) or similar procedures that remove prostate tissue from the inside. These operations have a long track record and remain a good choice for many men. PAE is a different approach that some men prefer to discuss first.

PAE is performed by an interventional radiologist. Through a small puncture in the groin or wrist, a thin catheter, about as fine as a strand of spaghetti, is guided through the blood vessels using live X-ray imaging until it reaches the small arteries that supply the prostate.

Tiny particles are then injected to partially reduce the blood flow to the gland. With less blood supply, the prostate tissue gradually shrinks and softens, which relieves pressure on the urethra. Improvement is not immediate: it typically develops over the following weeks.

Because the procedure works through the blood vessels, there is no abdominal incision and nothing is passed through the urethra. You can read a detailed walk-through in our guide, Prostate Embolization (PAE): What You Need to Know.

One of the most important studies is a randomized, sham-controlled trial published in European Urology in 2020. It enrolled 80 men with severe BPH symptoms that had not responded adequately to medication. Half underwent real PAE; the other half underwent a sham procedure in which the catheter was placed but no embolization was performed. Patients did not know which group they were in.

At six months, the improvement in the International Prostate Symptom Score (IPSS) was 13.2 points greater on average in the PAE group than in the sham group, and quality-of-life scores also improved significantly more. Adverse events occurred in 35.0% of men after PAE and 32.5% after sham, a similar rate. The authors concluded that the improvements after PAE were far beyond what a placebo effect could explain. They also noted the limitations: a single center, men with severe symptoms only, and follow-up of 12 months.

In Dr. Adam Farkas’s clinical experience, success rates for these catheter-based treatments range from 70% to 90%, depending on the individual case. This is not a guarantee, and every patient is assessed individually.

PAE is typically considered for men who:

• Have bothersome urinary symptoms caused by BPH
• Did not improve enough on medication, or could not tolerate it
• Prefer to avoid surgery, or face higher surgical risk because of other health conditions

Suitability is decided after a full evaluation, which includes confirming that BPH is the cause of the symptoms and assessing the prostate and its blood supply. More background is available on our Enlarged Prostate (BPH) page and on the Prostate Artery Embolization treatment page.

PAE is done as a day procedure. You arrive, have the procedure, and in most cases go home the same day. It is performed under local anesthesia at the catheter entry site, together with sedation to help you relax. General anesthesia is not needed.

The most common worry before any catheter procedure is pain. In practice, discomfort during PAE is minimal, and local anesthesia and sedation reduce it further. In the days afterwards some men notice burning when urinating, temporary frequency, or mild pelvic discomfort. The team explains in advance what to expect and when to call.

Surgery removes prostate tissue directly, and it has decades of experience behind it. PAE shrinks the prostate by reducing its blood supply. In Dr. Farkas’s clinical approach, PAE is an alternative to surgery with fewer complications and a much shorter recovery for suitable patients. Surgery may still be the better choice for some men, for example when the prostate anatomy or other findings call for it.

The right option depends on your symptoms, test results, other health conditions, and personal priorities. A consultation is the place to weigh these together.

If nighttime trips to the bathroom and a weak stream are shaping your days, it is worth finding out whether PAE is suitable for you. Dr. Adam Farkas, an interventional radiologist, sees patients for consultation at a clinic in Modi’in. Book a consultation.

This article provides general information and does not replace personal medical advice. Treatment decisions are made only after evaluation by a physician.