Prostatic artery embolization (PAE) improved subjective/objective benign prostatic hyperplasia (BPH) parameters and sexual function at all timepoints, with “very few” exceptions, say investigators of a recent real-world analysis of patients undergoing the treatment.
Despite inclusion in the 2026 American Urological Association (AUA) guideline, its specific guidance on use-cases for PAE remains limited. The investigators, led by Gabriel M Knight (Northwestern University, Chicago, USA), sought to answer remaining questions surrounding the safety and efficacy of PAE across patient subpopulations.
Published in the journal CardioVascular and Interventional Radiology: Endovascular, the study included 302 patients ≥45 years of age who underwent PAE for BPH refractory to/contraindicated for medical treatment from January 2015 until December 2024 at a single centre.
Findings showed that the average decrease in International Prostate Symptom Score (IPSS) was 56.4% at six months and 52.8% at 12 months after PAE. Clinical success was achieved in 186 of 199 patients (93.4%) at six-month follow-up and 151 of 162 patients (93.2%) at 12-month follow-up.
“The present study showed PAE to be safe and effective in patients with hopes to preserve or even improve sexual function, history of prior BPH intervention, larger gland sizes, higher comorbidity, catheter-dependent urinary retention, renal insufficiency, and haematuria,” Knight and colleagues write.
Expanding on these areas in their discussion, the investigators state that the present data suggest PAE should be recommended to patients with broader comorbidity profiles and to preserve, and “possibly improve”, sexual function.
Knight and colleagues state that their investigation offers “insight into real-world scenarios and patient factors that reinforce and extend the 2026 AUA guideline recommendation for PAE”. The authors acknowledge that longer-term data are needed to assess the durability of the technique but defend PAE’s “unique advantages” compared to surgical therapy in this patient population.
