Good point.

PAE is up and coming however lacks rigorous long term follow up. There is a reason for this - interventional radiologists aren't equipped (flow testing, u/s to check for post void residual) and don't have clinics to monitor long term outcomes (3 month post op checks followed by yearly follow up). The difference in follow up makes it very difficult to know what the true outcomes of the procedures actually are. When we looked at the data about 5 years ago, the AUA recommended PAE to be considered experimental. Since that time, more studies have come out and now PAE is considered to be at the level of MIST treatments (minimally invasive like urolift or rezum which make a trade off of durability for sparing of sexual side effects). Like all BPH treatments it is probably best served in specific clinic circumstances. PAE largely works by shrinking the prostate by choking off the blood supply to the gland - the amount of tissue that goes away is variable, and this really, really varies based on the accuracy and vigilance of getting the key blood vessels going to the prostate - this is not easy by any means. Patients should consider taking dutasteride or finasteride for a year as this mimics the approach without ANY surgical risk (reduces blood supply to prostate and thus shrinks it). In my mind, PAE is promising but not yet proven for the average BPH patient, I have seen several PAE failures for which I had to resect residual tissue. In my mind, the current ideal candidate is someone on blood thinners who cant come off of them with an enormous gland and is pretty sick (risky for anesthesia). We have exceptionally talented IR MDs in Rochester who I have personally seen operate - so if you opt for this approach come to Mayo. Hope this helps.

Dr. Kohler
Professor of Urology
Mayo Clinic Rochester, MN