10 Myths and Misconceptions about Prostate Artery Embolization (PAE)

1. PAE is experimental

• Myth. The truth is that prostate embolization has been performed for nearly 50 years. The first reported case was in 1977. It has been performed routinely for prostate enlargement since 2000, and it has been FDA approved since 2017. There is a wealth of data supporting the procedure including 6 randomized controlled trials (the strongest form of evidence) and 20 prospective trials. PAE is listed as a treatment for benign prostatic hypertrophy (BPH) in the American Urological Association (AUA) 2023 guidelines.

2. PAE is painful

• Myth. The truth is that PAE is a painless procedure. A small amount of lidocaine is used to numb the skin of the wrist or groin prior to inserting a tiny tube to perform the procedure with x-ray. A patient cannot feel any other part of the procedure. For a few days after embolization, some men may experience mild pelvic discomfort or irritation when urinating.

3. PAE is risky

• Myth. The truth is that PAE is a very safe procedure when performed by an experienced Interventional Physician. Major complications are very rare, occurring in less than 1% of cases. Permanent injury to structures other than the prostate have not been reported.

4. PAE causes erectile dysfunction (ED)

• Myth. The truth is that the majority of patients who undergo PAE experience no change in erectile function. ED following PAE is an exceptionally rare outcome. A sizeable proportion of men (~34%) experience improved erectile function following PAE. PAE is the only minimally invasive BPH treatment that may improve erectile function.

5. PAE causes incontinence

• Myth. The truth is that surgical procedures such as transurethral resection of the prostate (TURP) and prostatectomy can result in incontinence. PAE does not.

6. PAE requires a foley catheter

• Misconception. Some patients are dependent on a foley catheter because of BPH. These patients will keep a foley catheter in place until 2 weeks after a PAE when they undergo a voiding trial. If a patient does not have a foley catheter prior to a PAE, he will not have one placed for the procedure in our practice.

7. PAE involves a long-term recovery

• Myth. The truth is that there is a rapid recovery following PAE. These procedures are performed through an artery in the wrist in our practice. A patient can get out of bed and walk immediately following the procedure. Discharge is typically less than 90 minutes after the end of the procedure. Patients are encouraged not lift heavy objects with the left arm for 3 days after the procedure. Otherwise there are no physical limitations. Patients may experience mild pelvic discomfort and irritation when urinating for a few days after a PAE. 

8. PAE is only for patients who cannot have surgery

• Myth. The truth is that there are very few reasons why a patient could not have a PAE: severe vascular disease with blockages of the prostate arteries and extreme obesity. PAE has been shown to be effective in prostates of all sizes. Complications are less common and less severe with PAE than with surgery. Virtually any man who is a candidate for prostate surgery is a candidate for a PAE as an alternative.

9. PAE doesn’t work if a patient has had prior prostate surgery (example: TURP)

• Myth. The truth is that PAE can be effective regardless of any prior prostate procedure (except surgical removal of the prostate). Any patient can experience a return of symptoms over time after any prostate intervention since the prostate continues to grow in response to the body’s hormones. If a patient has lower urinary tract symptoms from BPH, PAE is an effective treatment option regardless of prior procedures or surgery.

10. PAE is not covered by Medicare or private insurance

• Myth. PAE is covered by Medicare, and it is covered by most private insurance plans. Patients should check with their individual insurers to confirm coverage.