I considered PAE 2 years ago but ended up deciding against it. In hind sight, I made the right choice.

PAE works by eliminating the blood supply, the gland shrinks (atropy) over several weeks and decompresses the urethra.
During the procedure, millions of microscopic beads (embolic agents) are injected into these blood vessels, permanently cutting off the nutrient and blood supply to the hyperplastic prostate tissue.

Tissue removed : ~25% to 40% reduction via volume atrophy; 10 year durability as prosate revascularises and regrows.

Tissue removed (eg Holep): ~50% to 80%+ of the central tissue is cleared; a permanent life-long fix.

Because BPH is a progressive, hormonally driven condition, any tissue left behind will continue to grow over time. As PAE only shrinks the tissue rather than remove it, the prostate will sprout new blood vessels (revascularise) and cause symptoms to return years "in a few years time" necessiting another prostate reduction procedure.

UPSIDE: unlikely retrograde ejaculation as bladder neck muscle is spared which means there is tissue left behind to keep growing.

DOWNSIDE: Expect blockages in week one. Pack a small bag you can take with you to ER in case of emergency.