Prostate artery embolization (PAE)
Prostate artery embolization is done by an interventional radiologist through a tiny tube in an artery in the groin or wrist. Tiny particles are injected into the prostate's arteries to reduce its blood supply, so the prostate softens and shrinks over the following weeks.
Also called PAE, prostate artery embolization, prostatic artery embolization, prostate embolization, embolization for BPH, interventional radiology prostate procedure, shrink prostate without surgery, prostate procedure through the groin
- Where
- Interventional radiology suite in a hospital or outpatient center
- Anesthesia
- Local numbing with moderate sedation (relaxed and drowsy, but breathing on your own)
- Time in the room
- About 1 to 3 hours
- Hospital stay
- Same day
- Going home with
- Usually none; some teams place a temporary catheter during the procedure
- Back to normal
- About 1 week
- Back to work
- Often within a few days
Overview
In BPH (benign prostatic hyperplasia), the inner prostate grows and squeezes the urethra, the tube that carries urine out. PAE treats this by cutting down the prostate's blood supply. It is done by an interventional radiologist, a doctor who treats problems through blood vessels using X-ray guidance, usually working together with your urologist.
A thin tube called a catheter is passed into an artery through a small puncture in the groin or the wrist. Using X-ray pictures and dye, the doctor steers an even thinner tube into the small arteries that feed each side of the prostate. Tiny round particles, smaller than grains of sand, are injected to block those arteries. With less blood flow, parts of the prostate soften and shrink over the next weeks to months.
PAE does not need general anesthesia, involves no cuts in the urethra, and rarely affects ejaculation or erections. It can treat very large prostates. The trade-offs are that the improvement is usually smaller than with surgery that removes tissue, results take longer to appear, and more men need another treatment within a few years.
Urology and radiology guidelines in the United States and Europe now describe PAE as an option for selected men, with honest counseling about these trade-offs. It is best done by a team experienced with the procedure, after a full urology evaluation.
The parts of your body involved
Each side of the prostate is fed by small prostate arteries that branch off arteries deep in the pelvis. These vessels are small, often twisted, and close to arteries that feed the bladder, rectum, and penis. That is why careful mapping beforehand matters.
- Prostate
The gland below the bladder that has grown and narrowed the urethra.
- Prostate arteries
Small arteries feeding each side of the prostate. These are the targets.
- Groin or wrist artery
The entry point for the catheter: the femoral artery in the groin or the radial artery in the wrist.
- Nearby arteries
Branches to the bladder, rectum, and penis that the team takes care to avoid.
- Bladder
Sits above the prostate. Some teams fill it with a little dye-tinted fluid to help see it on X-ray.
Why it’s done
PAE is offered to men with bothersome BPH symptoms who want to avoid surgery or general anesthesia, want to protect ejaculation, or have health problems that make surgery risky.
- Avoiding surgery
No incisions in the urethra and no general anesthesia.
- Large prostates
Size is not a barrier the way it is for some other options.
- Protecting sexual function
Ejaculation and erections are usually preserved.
- Higher surgical risk
Men with heart or lung disease or who cannot stop blood thinners may be better suited.
- Bleeding prostate
PAE can stop repeated bleeding from a large prostate.
Other options
- Watching and waiting or medicines
Lifestyle changes, alpha blockers, or finasteride and dutasteride to shrink the prostate over months.
- HoLEP
Removes the inner growth with a laser; larger improvement, very durable; most men have dry orgasms.
- TURP
Standard surgery for 30 to 80 gram prostates.
- Rezum or UroLift
Office options through the urethra that usually protect ejaculation.
- Simple prostatectomy
For very large prostates, through the belly.
Getting ready
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Weeks before
The week before
The day of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Lying under the X-ray camera
You lie flat on your back on the procedure table, under a large C-shaped X-ray machine. You get sedation through your IV to feel relaxed and drowsy. Monitors track your heart and oxygen.
After the operation
Right afterward
- Lying still
After a groin puncture, you lie flat for a few hours to prevent bleeding. A wrist puncture lets you sit up sooner.
- Checking the puncture
Nurses check the site and the pulse in your foot or hand.
- Urinating
You urinate before going home. Any temporary catheter is removed.
- Going home
Same day, with medicines for pain, inflammation, and sometimes nausea or bladder irritation.
At home
- Post-embolization symptoms
Many men have pelvic or rectal ache, burning, frequent urination, mild fever, tiredness, or nausea for several days. This is the expected reaction to the treated tissue.
- Puncture site
A small bruise is normal. Avoid heavy lifting and strenuous activity for about a week.
- Blood
A little blood in urine, semen, or stool can happen for a short time.
- Drinking
Drink plenty of water to help clear the dye and soothe the bladder.
- Showering
Usually after 24 hours. No baths or swimming until the puncture heals, about a week.
- Sex
Usually after about a week, when comfortable.
Recovery timeline
- Day 0Procedure
Home the same day after resting flat.
- Days 1 to 7Post-embolization symptoms
Pelvic ache, burning, frequency, and tiredness, which fade over the week.
- Weeks 2 to 4First improvement
Some men notice a better stream.
- 1 to 3 monthsSteady gains
The prostate continues to shrink.
- 3 monthsFollow-up
Symptoms, flow, emptying, and often prostate size are checked.
- Long termDurability
Most men keep benefit for several years, but retreatment is more common than after surgery.
What it feels like
Men describe the procedure as long but tolerable, with the hardest part lying flat afterward and feeling flu-like for a few days.
On the table
Drowsy, sometimes bored, with a warm flush from the dye.
What helpsTell the team if you feel pain; they can give more medicine.
Lying flat
Back stiffness and boredom while resting after a groin puncture.
What helpsAsk about a wrist approach if lying flat is hard for you.
The first week
Burning, frequency, pelvic ache, and tiredness, sometimes a low fever.
What helpsAnti-inflammatory medicine as prescribed, rest, and fluids.
Waiting for results
Impatience, since improvement takes weeks.
What helpsKnow that change is gradual and keep a simple symptom diary.
Months later
Easier urination for most, with sex life unchanged.
What helpsKeep follow-up visits with both your radiologist and urologist.
How well it works
Most men improve, though usually less than with surgery that removes tissue. Results build over 1 to 3 months.
- Symptoms
Many men see their symptom score fall by about half, with the change building over months.
- Flow
Flow rate usually improves, but less than after TURP or HoLEP.
- Sexual function
Ejaculation and erections are usually preserved.
- Retreatment
Roughly 1 in 5 men need another treatment within a few years, more than after surgery.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Pelvic or rectal ache, burning, frequency, mild fever, or nausea for several days.
Usually small.
Usually brief.
Less common
Some men improve only a little.
More common than after surgery.
Treated with antibiotics or a short-term catheter.
When arteries on one side cannot be reached.
Rare
Can injure part of the bladder, rectum, or penis. Rare in experienced hands.
Rarely needs another procedure.
Rare.
Rare, with long procedures.
Call your care team or go to the emergency room if
- Bleeding or a growing lump at the puncture site (press firmly and call 911 if it does not stop)
- Cold, numb, or pale leg or hand on the side of the puncture
- Fever of 101°F (38.3°C) or higher after the first 2 to 3 days, or shaking chills
- Not able to urinate for 6 hours, or a painful, full lower belly
- Heavy rectal bleeding or severe pain that keeps getting worse
- Sores or skin color changes on the penis or buttocks
Questions to ask your surgeon
- Has a urologist confirmed that BPH is causing my symptoms?
- How many PAE procedures has your team done?
- Will you go through my groin or wrist?
- Do I need a CT or MRI of my arteries first?
- How much improvement should I expect compared with surgery?
- What are the chances I will need another treatment?
- What will the first week feel like?
- What happens if you cannot reach the arteries on one side?
Words you may hear
- Embolization
- Blocking a blood vessel on purpose with tiny particles or other materials.
- Interventional radiologist
- A doctor who treats problems through blood vessels using X-ray guidance.
- Catheter
- Here, a thin tube placed inside an artery. (In urology, the same word also means a tube in the bladder.)
- Microcatheter
- A very thin tube that reaches small arteries.
- Femoral artery
- The large artery in the groin.
- Radial artery
- The artery at the wrist.
- Post-embolization syndrome
- Expected pain, fever, and tiredness for a few days after embolization.
- Non-target embolization
- Particles accidentally blocking an artery that was not meant to be treated.
- BPH
- Benign prostatic hyperplasia: non-cancer growth of the prostate.
Common questions
Who does PAE?
An interventional radiologist, usually after evaluation by a urologist.
Will I be put to sleep?
Usually not. You get sedation to stay relaxed, plus local numbing.
How soon will I feel better?
Some men notice a change in a few weeks, but most of the benefit builds over 1 to 3 months.
Will it affect my sex life?
Ejaculation and erections are usually preserved. Some men notice less semen or a little blood in it for a short time.
Can I still have surgery later?
Yes. TURP, HoLEP, or other procedures remain possible if needed.
Is it right for very large prostates?
It can be used for very large prostates, which is one of its strengths.
Sources this page draws on
- American Urological Association, Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia (BPH): AUA Guideline
- European Association of Urology, EAU Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms
- Society of Interventional Radiology, Multisociety consensus quality improvement statement on prostatic artery embolization
- National Institute for Health and Care Excellence (NICE), Prostate artery embolisation for lower urinary tract symptoms caused by benign prostatic hyperplasia
- Urology Care Foundation, Benign Prostatic Hyperplasia (BPH)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.