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Comparative Effectiveness Review of Prostatic Artery Embolization (PAE) for Treatment of Benign Prostatic Hyperplasia (BPH)

August 21, 2019

Health Problem: Benign prostatic hyperplasia (BPH) is an enlargement or growth of the prostate gland. An enlarged prostate restricts the urethra and applies pressure on the base of the bladder. This restriction of the urethra can interfere with urination and eventually cause more serious problems.

Technology Description: Prostatic artery embolization (PAE) is a minimally invasive procedure offered as an alternative to transurethral resection of the prostate (TURP) or open prostatectomy. PAE selectively occludes branches of the prostatic arteries, deprives the enlarged prostate of blood supply and nutrients, which leads to ischemic necrosis and shrinkage of the affected section of the prostate gland.

Controversy: PAE may not be as effective as TURP due to inability to access all branches of the prostatic artery. In addition, it requires an experienced interventional radiologist and surgical suite that provides intraoperative fluoroscopic imaging. Despite evidence that PAE might be less effective than TURP, there may be certain populations who are better candidates for this procedure than for TURP.

Key Questions:

  • Is PAE effective for reducing lower urinary tract symptoms (LUTS) associated with benign BPH?
  • How does PAE compare with usual surgical treatments for BPH (e.g., TURP)?
  • Is PAE safe for treatment of BPH?
  • Have definitive patient selection criteria been identified for use of PAE to treat BPH?