Current considerations in prostate artery embolisation.

Area of Science:

• Interventional Radiology
• Urology
• Vascular Medicine

Background:

• Prostate artery embolisation (PAE) is a minimally invasive procedure for treating lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH).
• Systematic reviews and meta-analyses confirm PAE's safety and efficacy.
• Despite established evidence, practical and technical aspects of PAE remain subjects of discussion.

Purpose of the Study:

• To review the current evidence and technical considerations for prostate artery embolisation (PAE) in managing benign prostatic hyperplasia (BPH).
• To highlight the safety, efficacy, and evolving role of PAE within the BPH treatment algorithm.

Main Methods:

• PAE involves inducing ischaemia in the prostate's transitional zone using permanent embolic agents (microparticles or liquid embolics).
• Pre-procedural imaging like CTA and cone beam CT aids in anatomical definition and risk reduction.
• Both femoral and radial access routes are viable, with radial access often preferred for patient comfort.

Main Results:

• Microparticle embolics have extensive evidence supporting their safety and efficacy.
• Liquid embolics may decrease procedure time and radiation dose but require operator expertise.
• PAE is supported by recent evidence as a first-line therapy or adjunct to surgery for BPH.

Conclusions:

• Prostate artery embolisation (PAE) is a credible, evidence-based treatment option for BPH, comparable to surgery and medication.
• Technical variations exist in embolic choice, access, imaging, and procedural sequencing.
• An anatomy-driven approach prioritizing precision, embolic control, and patient-centered decisions is recommended over rigid adherence to a single technique.