Prostate Artery Embolization (PAE) Treatment for BPH

BPH is one of the most common conditions affecting men as they age. By age 55, roughly 25% of all men have some degree of prostate enlargement. By age 85, that figure approaches 90%. For many men, symptoms are manageable with lifestyle changes or medication. For others — particularly those whose symptoms disrupt sleep, limit daily activity, or haven’t responded to medication — a more targeted treatment becomes necessary.

BPH symptoms may include:

• Difficulty starting your urinary stream
• Weaker urine stream
• Inability to completely empty the bladder
• Straining to urinate
• Waking up at night to urinate (nocturia)
• Sudden urge to urinate
• Frequent urination, more often than normal
• Urine leakage

When the prostate is enlarged, the extra tissue presses against the urethra — the tube that carries urine from the bladder out of the body. In men, the urethra is about eight inches long and runs through the prostate and penis. That pressure is what causes the symptoms above.

Prostate artery embolization (PAE) is a minimally invasive treatment for men experiencing symptoms of BPH. Unlike traditional surgical options, PAE does not require general anesthesia, an overnight hospital stay, or incisions large enough to need stitches. The entire procedure is performed through a single small puncture, about the size of a pencil tip, in the wrist or upper thigh.

PAE causes the prostate to shrink, which relieves the pressure on the urethra and resolves the symptoms of BPH.

PAE is performed by a specialist called an interventional radiologist. Unlike a surgeon who operates through incisions, an interventional radiologist uses real-time imaging (X-rays, fluoroscopy, and other techniques) to guide small instruments through the body’s natural pathways, primarily blood vessels. The result is a procedure that achieves meaningful clinical outcomes without open surgery, general anesthesia, or extended recovery.

Interventional radiologists complete medical school followed by five to six years of specialized residency and fellowship training. PAE is one of several minimally invasive procedures that have emerged from this specialty to offer patients alternatives to traditional surgery.

Colorado Springs Urology performs PAE at our state-of-the-art Advanced Therapies Center at 1644 Medical Center Point, Suite 100, an outpatient facility built for PAE and other advanced, image-guided procedures.

To perform PAE, an interventional radiologist uses X-rays and live imaging to navigate through blood vessels with precision. Here is what the procedure involves:

1. The patient receives light sedation, sometimes called conscious sedation or twilight sleep. Most patients are relaxed and comfortable throughout and have little memory of the procedure.
2. A small catheter (flexible thin tube) is inserted into an artery at the top of the leg or in the wrist through a puncture no larger than a pencil tip. No stitches are required.
3. The catheter is guided through the arterial system into the blood vessels that supply blood to the prostate, using live X-ray imaging called fluoroscopy.
4. Tiny round microspheres (particles) are injected through the catheter into the arteries feeding the prostate. These particles become lodged in the vessels and significantly reduce blood flow to the prostate.
5. Over the weeks that follow, the reduced blood supply causes the prostate to gradually shrink toward a more normal size.
6. Once the prostate shrinks, the pressure on the urethra is relieved and urination returns to normal.
7. The full procedure takes 45-90 minutes, with patients going home the same day.

By age 55, about one in four men have symptoms of an enlarged prostate (BPH), as do half of 75-year-old men. By age 85, about 90% have BPH symptoms.

For many men, the path to PAE begins after trying medications that either haven’t worked well enough or have caused side effects — most commonly related to sexual function or blood pressure — that affect quality of life.

Your doctor may recommend PAE if:

• You have urinary symptoms that are interfering with your quality of life.
• You want to avoid surgery or are not an ideal candidate for traditional surgery.
• Medications for BPH have not provided sufficient relief, or have caused side effects that you prefer to avoid.

PAE is a treatment option:

• Regardless of the size of your prostate. PAE is an excellent option even for men with extremely large prostates.
• Regardless of your age. Age does not affect the effectiveness of PAE.
• Even if you have had a previous prostate surgery or another treatment (such as TURP) for BPH.

Learn more about when to consider PAE.

You may be considered ineligible for PAE if:

• Your doctor suspects prostate cancer. Prostate cancer must be ruled out before proceeding with PAE. Your doctor will likely want a PSA blood test and possibly a digital rectal exam before moving forward.
• You have an active infection in your urinary system. PAE could spread bacteria into the bloodstream during the procedure. Once the infection is fully treated and resolved, you would likely be a suitable candidate.
• You have significant atherosclerosis — a hardening and narrowing of the arteries. PAE relies on being able to navigate a catheter through arteries, and severe atherosclerosis can make that navigation difficult.
• You have kidney disease. Proper imaging during PAE requires contrast dye that the kidneys process. A blood test can determine whether kidney function is sufficient.
• You are allergic to contrast dye, which is used to visualize the arteries during PAE. Ask your doctor if there are alternatives.

To find out if PAE is right for you, ask your urologist.

Prostate Artery Embolization (PAE) and Transurethral Resection of the Prostate (TURP) are both effective, well-studied treatments for BPH. TURP has been the surgical standard of care for decades and remains the benchmark against which other treatments are compared. PAE is a newer option with a growing body of clinical evidence supporting it as a safe and effective alternative, particularly for patients who want to avoid surgery or anesthesia, have very large prostates, or are concerned about sexual side effects.

The right choice depends on your situation: the size of your prostate, your overall health, your priorities around recovery, and how you weigh different risk profiles. The table below outlines the key differences:

A landmark randomized controlled trial published in the BMJ directly compared PAE to TURP. While TURP produced slightly greater symptom reduction overall, PAE produced comparable improvements in quality of life with significantly fewer side effects, particularly regarding sexual function. For many patients, that trade-off is exactly what makes PAE the right choice.

Read our detailed comparison of PAE vs. TURP, including recovery timelines and side effect profiles

Recovery from PAE is considerably shorter than recovery from TURP or traditional prostate surgery. Most patients are home the same day and return to light activity within a few days.

Following the procedure, you will remain in the recovery room until your care team is confident you are ready to leave. Once home, you can expect:

• No catheter needed to drain urine
• Temporary worsening of existing urinary symptoms in the first week — this is normal and expected
• Symptoms beginning to improve around three weeks after the procedure
• Continued improvement over the following several months as the prostate shrinks
• A feeling similar to a urinary tract infection (burning, urgency) for several days, which resolves on its own
• Return to full activity in approximately one week

Post-Embolization Syndrome

Some patients experience what is known as post-embolization syndrome in the days following PAE. This can include low-grade fever, fatigue, nausea, and pelvic discomfort. This is not a complication or infection; rather, it is the body’s natural inflammatory response to reduced blood flow in the prostate tissue. It typically resolves within one week and is managed with rest and over-the-counter anti-inflammatory medications.

Medications After PAE

Before you leave the Colorado Springs Urology Advanced Therapies Center, your care team will go over discharge instructions and any medications prescribed to support your recovery. These commonly include anti-inflammatory medications, pain relievers, and in some cases a short course of antibiotics as a precaution.

Follow-Up Care

Your Colorado Springs Urology physician will schedule a follow-up appointment to assess how your symptoms are responding. Imaging may be used to confirm that the prostate has reduced in size as expected. Most patients notice meaningful improvement by their first follow-up visit, and results typically continue developing for up to six months or more.

PAE has very low complication rates. Erectile dysfunction or urinary incontinence are very rare. See our complete PAE recovery guide — what to expect day by day.

Medicare, TRICARE, VA

• Medicare covers PAE when it is deemed medically necessary and performed by a qualified interventional radiologist. Documentation supporting medical necessity — including your symptom history, relevant test results, and prior treatment attempts — is typically required for approval. A referral from your primary care physician is necessary.
• TRICARE and the VA have also approved coverage for PAE.

Commercial Insurers

• Coverage decisions are made on a case-by-case basis and depend on your specific plan, your documented symptom history, and whether conservative treatments such as medications have already been tried and found inadequate.
• Coverage is currently pending with Aetna, Humana, United, Kaiser, UMR, and BCBS. Prior authorization is typically required.
• Before you assume one way or the other if you have coverage or if a referral is needed, please check with your insurance provider.

Research consistently shows strong outcomes for PAE across multiple long-term studies. In published clinical trials, 85–90% of men experience a significant reduction in BPH symptoms within the first year following PAE. After three years, approximately 80% of men continue to report meaningful symptom relief, and at 6.5 years, 76% of men report sustained improvement.

Clinical studies measure outcomes using standardized tools like the International Prostate Symptom Score (IPSS), which tracks urinary frequency, urgency, flow rate, and nighttime urination. Studies consistently show 20–40% reduction in prostate volume following PAE, alongside improvements in urine flow rates and quality-of-life scores.

The Society of Interventional Radiology and other major clinical bodies now recognize PAE as a safe and effective treatment for BPH, particularly for patients with large prostate volumes or those seeking to preserve sexual function.

Yes. And in many ways, PAE is particularly well-suited for men with very large prostates. Traditional surgical approaches like TURP become technically more challenging as prostate volume increases, and they can carry higher complication risks in those cases. PAE does not share this limitation in the same way.

PAE is considered a safe and effective treatment for prostates over 80-150 grams and has been performed successfully on glands exceeding 500 grams. Research suggests the procedure may actually work especially well on larger prostates because the blood vessels supplying a larger gland tend to be more prominent, making them easier to target precisely with a catheter.

If you have been told your prostate is too large for conventional surgery, or that surgery would carry significant risks given your anatomy, PAE is worth discussing with a Colorado Springs Urology physician who specializes in the procedure. Prostate size alone is rarely a reason to rule it out.

Below are the questions patients most commonly ask when considering PAE. If you don’t see your question here, we encourage you to bring it to your consultation with your urologist at Colorado Springs Urology.

How long does a PAE procedure take?

The procedure itself takes 45–90 minutes. Plan for a half-day at our Advanced Therapies Center when you include preparation and post-procedure monitoring before going home.

Will I be asleep during PAE?

No. PAE is performed under light sedation, sometimes called conscious sedation or twilight sleep. You’ll be relaxed and comfortable throughout, but not fully unconscious. Most patients have little or no memory of the procedure.

How soon will I notice improvement?

Most patients begin noticing improvement around three weeks after PAE. Results continue to improve for several months as the prostate continues to shrink.

Does PAE affect sexual function?

One of the most frequently cited advantages of PAE over TURP is its preservation of sexual function. Unlike TURP, which carries a risk of retrograde ejaculation (dry orgasm), PAE has not been associated with sexual dysfunction in clinical studies.

Can PAE be repeated if symptoms return?

In cases where symptoms return after several years, PAE can potentially be repeated. Your physician will evaluate whether a repeat procedure is appropriate based on your anatomy and imaging at that time.

What if PAE doesn’t work for me?

If PAE does not provide sufficient relief, TURP and other surgical approaches remain available. This is one reason some patients choose PAE as a first step before considering more invasive surgery.

Is PAE a treatment for prostate cancer?

No. PAE treats BPH, an enlargement of the prostate that is benign (non-cancerous). It is not a treatment for prostate cancer. Prostate cancer must be ruled out before proceeding with PAE.

Do I need a referral to be evaluated for PAE?

The best first step is to schedule a consultation with a urologist at Colorado Springs Urology who can review your symptom history, imaging, and test results and determine whether PAE is an appropriate option for you.

Colorado Springs Urology performs PAE at our Advanced Therapies Center — an outpatient facility designed specifically for minimally invasive, image-guided procedures. Our team has the training and technology to evaluate whether PAE is appropriate for your situation and to perform the procedure with precision and care.

If you are experiencing symptoms of BPH and want to understand whether PAE is right for you, we encourage you to schedule a consultation. Our physicians will review your medical history, imaging, and test results, discuss your goals, and walk you through all available options — including PAE, TURP, and medical management — so you can make an informed decision.