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As men age, changes may occur in the prostate gland. Cells in this gland can begin to grow, causing it to get bigger.

Doctors call an enlarged prostate benign prostatic hyperplasia (BPH). According to the National Library of Medicine, this condition affects more than half of men in their 50s.

An enlarged prostate gland can cause problems with urinating. When lifestyle changes and medicine don’t help these symptoms, doctors consider procedures and surgery. A minimally invasive procedure called prostate artery embolization (PAE) is growing in popularity as a treatment for benign prostatic hyperplasia.

“The prostate sits like a donut around the urethra,” says Anish G. Ghodadra, MD, a board-certified interventional radiologist at UPMC. “As the prostate grows, it squeezes the urethra and puts pressure on it. With PAE, we are able to cut off blood supply to the prostate, causing it to shrink over time and alleviate symptoms.”

What Is Benign Prostatic Hyperplasia (BPH)?

BPH is a common condition in men as they age. It isn’t prostate cancer and doesn’t increase your risk of prostate cancer. However, BPH can cause urinary problems that affect your quality of life.

The prostate makes fluid that carries sperm in the ejaculate. The urethra, the tube that carries urine, runs through the middle of the prostate. When hyperplasia occurs, the prostate presses on the urethra, causing narrowing or blockages.

BPH symptoms

Benign prostatic hyperplasia can interfere with urine leaving your bladder.

It can cause:

• Frequent urination.
• Slow or weak urine stream.
• Strain or pain when urinating.
• Inability to fully empty your bladder.

You may not have any BPH symptoms, and you can live a long life with BPH. However, urinary symptoms may begin or worsen as prostate size increases. When these symptoms interfere with your life, talk to your doctor about treatment options.

Can You Shrink an Enlarged Prostate?

Once your prostate enlarges, you can’t shrink it naturally. However, lifestyle changes may help control mild BPH symptoms.

These include:

• Avoiding alcohol and caffeine.
• Performing exercises to strengthen pelvic floor muscles.
• Reducing your fluid intake.
• Treating constipation (if you experience it).

How Do Doctors Treat BPH?

Your doctor may recommend certain treatments when BPH symptoms worsen. “Generally, we start with the least invasive option, which is medication,” Dr. Ghodadra says.

Medicines

Medicine may help stop prostate growth or shrink enlarged tissue to reduce symptoms.

Your doctor may prescribe:

• Alpha-blockers — These drugs relax muscles to improve urine flow.
• Phosphodiesterase-5 inhibitors — These medicines relax urinary tract muscles.
• 5-alpha reductase inhibitors — These drugs stop the production of a hormone called dihydrotestosterone.

Doctors may prescribe a combination of drugs. Side effects may include headaches, dizziness, and fatigue.

That’s one reason PAE can be the best treatment choice for some men, according to Dr. Ghodadra. “Our goal is to get people off medications because some have significant side effects,” he says.

Prostatic Artery Embolization

PAE is an outpatient procedure. It reduces blood supply to the prostate to shrink it and improve urine flow.

What to expect during the PAE procedure

“When we perform the PAE procedure, we use ‘twilight sedation.’ so it’s not full anesthesia,” Dr. Ghodadra says. “You’ll be very relaxed.”

Your interventional radiologist makes a pinhole incision in your wrist or groin. They then insert a flexible tube called a catheter into the incision, which is moved through the bloodstream until they reach the prostate. They use a special x-ray called fluoroscopy to guide the procedure.

“We use the x-ray to map vessels that supply blood to the prostate,” Dr. Ghodadra says. “Then, we thread catheters into those blood vessels.”

After placing the catheters, the radiologist injects tiny plastic beads, blocking the blood from traveling in those vessels. A lack of blood supply causes the prostate to shrink.

“When the prostate shrinks, this releases pressure on the urethra and allows urine to flow,” he says.

Recovery after PAE

The PAE procedure usually takes between two and four hours. After the procedure, you’ll be in a recovery area until you wake fully from sedation. Most people go home the same day. To manage discomfort, you may take an anti-inflammatory medicine, typically ibuprofen.

You may also experience worsening urinary symptoms at first as the prostate begins to shrink. Urinary symptoms typically improve within a few days, Dr. Ghodadra says. You’ll likely notice significant improvement during the first month after PAE.

What Are the Benefits of PAE?

Prostatic artery embolization has several benefits over traditional prostate surgeries like transurethral resection of the prostate (TURP).

PAE benefits include:

• Less pain.
• Shorter recovery time.

Sexual side effects may occur in as many as 40% of patients who have traditional prostate surgery, according to Dr. Ghodadra. However, PAE does not cause sexual side effects like erectile dysfunction or problems with ejaculation. “That’s because all we’re doing is blocking the blood supply,” he says.

What are the disadvantages of PAE?

PAE does have some risks. “There’s a small risk of bleeding around the artery we access,” Dr. Ghodadra says. “But that risk is less than 1%.”

Other risks include infection and bladder spasms immediately after PAE. To minimize these risks, antibiotics and a bladder spasm medicine may be prescribed.

One downside of the PAE procedure is that it takes longer than other procedures. “There are many connections between the different arteries in the pelvis,” Dr. Ghodadra says. “These procedures take time because we map the anatomy carefully to ensure we’re accessing only arteries that supply blood to the prostate.”

Who Is the Ideal Candidate for PAE?

Dr. Ghodadra says men with larger prostates and large blood supplies are ideal candidates for PAE. “These arteries are easier to get into and easier to treat,” he says.

Who is not a candidate for prostate artery embolization?

People with neurogenic bladder — a condition in which the bladder can’t squeeze as it should — aren’t candidates for PAE. That’s because even if you take pressure off the urethra with PAE, the bladder still can’t function normally.

People with atherosclerosis also aren’t good candidates for PAE. “Narrowed arteries from atherosclerosis make accessing the arteries in the prostate very difficult,” Dr. Ghodadra says.

How Long Does Prostatic Artery Embolization Last?

PAE limits the prostate’s ability to regrow by reducing its blood supply. If the prostate does grow, it is much slower, Dr. Ghodadra says. If urinary symptoms return, retreatment with PAE may be an option.

How PAE Can Improve Your Life

BPH can cause urinary problems that disrupt your life. “Some men can’t go to a ball game or a movie or sleep through the night,” Dr. Ghodadra says. Some men can’t urinate at all and need a catheter to remove urine from their bodies.

Treatment with PAE can help, he says. “I saw an 81-year-old a couple of months ago and treated him with this procedure,” he says. “He told me, ‘You made my prostate feel like I’m 30 again.'”

Learn more about interventional radiology at UPMC.