An enlarged prostate can start mild and barely noticeable, with an extra bathroom trip at night that progresses into a slower stream and then a feeling that the bladder never fully empties. Some men wait for years before bringing these changes up with their doctor. By then, the conversation may quickly jump to discussing surgery. 

At Orange County Interventional Radiology, we offer a treatment called prostate artery embolization (PAE) that can be just as effective as surgery, but less invasive with fewer side effects. If your symptoms cannot be managed with medication, but surgery is not a good option for you, we would love to talk to you about PAE.

The Progression From Mild Symptoms to Major Surgery

Benign prostatic hyperplasia (BPH) is a noncancerous condition that causes the prostate gland to grow, often in men over 50. Once it gets larger, it can squeeze the urethra and cause symptoms like a weak stream that starts and stops or the frequent need to pee. It is a very common condition and is considered virtually inevitable for men who live long enough; however, common does not mean this condition should simply be accepted as part of aging. If you are experiencing discomfort from an enlarged prostate, it is worth discussing your options with your doctor. 

What Is Prostate Artery Embolization?

PAE is a minimally invasive procedure that reduces the size of the prostate by limiting its blood supply. During this treatment, a thin catheter is inserted into an artery in the hip or wrist and directed to the arteries feeding the prostate. We release tiny particles that eventually block blood flow to the area.  In response to this treatment, the prostate gradually shrinks and reduces pressure on the urethra and bladder. During PAE, no incisions are made on the prostate or any other areas.

Why Medications Stop Working for Many Men

Alpha-blockers and 5-alpha reductase inhibitors are usually the first prescriptions men receive for BPH. These medications either relax the smooth muscle in the prostate to help improve urine flow or decrease the volume of the prostate. These medications can be effective at first, but doses may need to be increased with time, and there can be side effects, such as sexual dysfunction and gynecomastia. Many men also do not like having to rely on medication every day. At this point, PAE can be considered to reduce the size of the prostate without relying on medication or surgery.   

How PAE Shrinks the Prostate Without Incisions

During the Procedure

PAE is performed with local anesthesia and a mild sedative if needed, and it is an outpatient procedure. Your interventional radiologist will make a tiny puncture in the radial artery at the wrist or the femoral artery near the groin. This is no more invasive than a standard IV. Next, we use live X-ray imaging to guide the catheter to the prostatic arteries, where we use microscopic particles to block the flow. The procedure takes around two hours, and you will be able to go home around two hours after the procedure. 

What Happens to the Prostate Over the Following Months

It will take time for your prostate to shrink after PAE. With reduced blood flow, the gland tissue will gradually soften and decrease in volume. You may begin to notice better urinary flow and fewer nighttime trips within the first month. Symptom relief usually reaches its peak by three to six months. 

Will I Need a Catheter?

Our patients are often concerned about whether or not they will need a urinary catheter after this procedure. This is not needed in most cases. Additionally, those who already have a catheter because of urinary retention from an enlarged prostate may be able to have it removed once PAE has been effective. A study has shown that 94% of patients dependent on a catheter can have it removed after three months.  

What the Research Shows About PAE

PAE has been studied for two decades. A 2024 study published in the Journal of Vascular and Interventional Radiology followed 1,075 men who underwent PAE and reported sustained relief of urinary symptoms with a low rate of repeat treatment. The Society of Interventional Radiology multisociety consensus statement has established it as a safe and effective procedure for BPH, with lower rates of complications than surgery and high rates of effectiveness.

Who Is a Good Candidate for PAE?

You may be a good candidate for this treatment if:

• You Have Tried Medication Without Relief: Men on alpha-blockers or 5-alpha reductase inhibitors who still wake multiple times a night or struggle may see improvement after PAE. 
• You Want to Preserve Sexual Function: PAE has a very low risk of erectile dysfunction or retrograde ejaculation, and may slightly improve erectile function. 
• You Have a Large Prostate That Limits Other Options: Some minimally invasive treatments are limited by prostate size. PAE works regardless of how large the gland has grown.
• You Are Not a Good Surgical Candidate: Men with heart conditions, diabetes or other risks that make general anesthesia unsafe can usually receive PAE without those concerns.
• You Have a Catheter Due to Urinary Retention: PAE can shrink the prostate enough to allow normal urination and remove the need for the catheter.

Comparing PAE to Surgery

The most common surgical treatment for BPH is transurethral resection of the prostate, or TURP. A scope is inserted through the urethra, and prostate tissue is cut away from inside the gland. It can be effective but requires general anesthesia, a hospital stay and a urinary catheter for several days. Recovery often involves blood in the urine for a week or longer, and there are possible complications like retrograde ejaculation, erectile dysfunction and urinary incontinence.

Newer options like UroLift and Rezum are less invasive than TURP but still place instruments through the urethra. Both have size limitations that could rule out men with significantly enlarged glands. PAE works entirely from outside the urinary tract, and most men return to desk work within two days. If a patient eventually needs surgery later, PAE will not interfere.

Schedule a PAE Consultation in Orange County

Our practice is led by Dr. Kevin Burns and Dr. Jimmy Ton, board-certified, fellowship-trained interventional radiologists who perform image-guided embolization procedures every day. If an enlarged prostate is interrupting your sleep or daily routine, PAE may be worth considering before surgery. Call Orange County Interventional Radiology at 949-919-6169 or book online to schedule at our Lake Forest, Mission Viejo or Irvine locations.