What is PAE?
PAE stands for prostate artery embolisation. This is an innovative procedure used to treat benign prostate hyperplasia (BPH) – a condition resulting in the enlargement of a prostate, a common cause for lower urinary tract symptoms (LUTS). It is considered to be a safe and effective method of symptom reduction and has been shown to yield great results: over 70% of men gain symptomatic improvement (decreases in prostate volume and increases in urinary flow rates) following the procedure, and undergoing PAE doesn’t prevent you from undergoing other prostate reduction procedures later on.
This is a complex procedure which can only be performed by a specialist interventional radiologist with expertise in the area.
What is recovery from PAE like?
Following your PAE, you will be given a prescription for antibiotics and advised to take painkillers and anti-inflammatory medication. Exercise, heavy lifting, and intercourse should be avoided for about a week following the procedure, and you may experience some tiredness and burning pain when passing urine in the next few days. These symptoms usually settle in around a week.
How is PAE performed?
PAE is generally done under sedation and a local anaesthetic. This makes PAE a viable option for men who can’t have the general anaesthetic required for more invasive treatments.
Following sedation, a tiny tube is inserted into the femoral artery via the groin area and guided into the prostate arteries using X-rays. This tube can also be inserted via the radial artery in the wrist, which allows for quicker mobilisation post-procedure and discharge from the hospital.
It is then used to deliver tiny particles which embolise (block) the arteries, reducing blood flow to the prostate and causing it to decrease in size in the days following the procedure. You may feel some minor burning sensations during treatment, but this is normal and rarely too painful. The entire procedure generally lasts 3-4 hours.
Following the procedure, you will need to remain in the hospital for up to two hours for a radial procedure and six hours for a femoral procedure. There is no need to remain overnight, and (unlike with more invasive treatment options like TURP) there is only a 5% risk of needing a catheter post-procedure.
What are the risks associated?
PAE is generally considered to be a very safe procedure, but like all surgical procedures it carries a small risk of complications.
- Haematoma – a small bruise may form at the needle’s insertion site. This is quite normal and nothing to be concerned about. It can be treated by painkillers and will generally clear up on its own.
- Pain – many patients experience some mild pain in the days following the procedure. This can usually be managed with over-the-counter painkillers and anti-inflammatory medication, but can occasionally become severe and warrant further intervention.
- Catheterisation – in about 2-5% of cases, the treatment may cause the prostate to swell as a response to the treatment and block urinary flow. If this happens, it may be necessary to insert a urinary catheter.
- Blood in the urine, semen, or stool – you may notice a small amount of blood in the days following your procedure. If your symptoms persist or bleeding becomes heavy, consult your doctor immediately.
- Bladder spasms – the bladder can contract involuntarily, which may cause an intense urge to urinate, bladder leakage, and pain.
- Infection – the prostate and needle insertion site may become infected if they are not adequately cared for in the following days.
- Post-PAE syndrome – this affects about 9% of men who undergo PAE. It is characterised by nausea/vomiting, perineal pain, and dysuria (painful or difficult urination)
What investigations will be needed?
Before you can undergo the PAE procedure, you will need to undergo a variety of imaging procedures which help to determine your suitability and detect any underlying issues you may have. The investigations you need will be discussed with your doctor during consultation, but may include:
- Renal tract/bladder ultrasound – these are used to assess the state of your prostate and may help identify any underlying issues.
- Urine flow study – this is used to calculate your flow speed, volume, and the time it takes for you to pass urine.
- Prostate-specific antigen (PSA) blood test – this is used to check for signs of prostate cancer
Should PAE be a suitable treatment option for your symptoms, further scans will generally be required. These include:
- CT angiogram – this is a specialised CT used to evaluate the blood vessels supplying the prostate
- Prostate MRI – this is done as a baseline to allow comparison after treatment as well as to exclude the possibility of any cancer in the prostate.
Other investigations and scans may also need to be conducted to rule out any signs of prostate cancer, as cancer will need to be dealt with in preference to benign prostate enlargement concerns.
Who can undergo PAE?
PAE is a relatively new procedure and may not be suitable for all people. However, its differences to the more traditional transurethral resection of the prostate (TURP) may make it a viable solution for prostate reduction for:
- Men who take antiplatelets or blood thinners/anticoagulants, as the risk of bleeding is much less than in more invasive treatments
- Men who can’t undergo general anaesthetic, as PAE is performed under a local anaesthetic instead
- Men considered to be ‘high risk’ for surgery, as PAE is a minimally invasive procedure with lower associated risks
- Men with very large prostates, for whom surgical options may be less safe or effective.
- Men with permanent urinary catheters who have been told that they don’t have another option – there are many documented cases of men being able to successfully remove their catheters following PAE
- Men who are sexually active, as evidence has shown that PAE preserves (and may be associated with improved) sexual function. PAE does not cause the retrograde ejaculation (failure to ejaculate) which is often seen in TURP.
- Men who don’t want to undergo surgery and whose symptoms are poorly controlled on medication – PAE is a much less drastic procedure than traditional surgery, and many men who don’t feel comfortable going under the knife are more at ease the procedure.
However, PAE may not be suitable for men with urinary tract symptoms (who may have an enlarged prostate without it being the main cause of their symptoms), associated problems such as bladder stones, or predominately night time symptoms (Nocturnia). Men with ‘mild’ symptoms (as assessed at the time of consult) are currently considered to be best treated with medication, rather than intervention.
Click here to read The UK National Institute for Health and Care Excellence (NICE)’s announcement of updating its guidance to include PAE as a suitable treatment for BPH.
Click here to visit the website for Ask4PAE, an educational patient program dedicated to raising awareness about BPH and its treatment options.