Prostatic Artery Embolization: A Contemporary Review of Efficacy, Safety, and Expanding Clinical Indications

Prostatic artery embolization (PAE) has emerged as a minimally invasive treatment for a spectrum of prostatic conditions. Supported by a growing body of randomized and observational evidence, PAE now occupies an established role in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and is increasingly applied for refractory prostatic bleeding and hematospermia. A structured review of PubMed, Google Scholar, and MEDLINE was performed with priority given to studies published from 2020 onward, including randomized controlled trials, prospective multicenter studies, large observational cohorts, and current guideline statements. Outcomes of interest included technical success, symptom improvement, urodynamic parameters, postvoid residual volume, hematuria resolution, retreatment rates, and adverse events.

For BPH-related LUTS, PAE produces meaningful and durable symptom improvement. However, it consistently demonstrates inferior urodynamic outcomes and higher long-term retreatment rates compared with transurethral resection of the prostate (TURP) and holmium laser enucleation. PAE's advantages include lower periprocedural risk in medically high risk patients and early preservation of sexual and continence-related function. For refractory prostatic bleeding - including BPH-related, malignant, and post-procedural etiologies - retrospective and prospective series consistently report high technical success and clinically meaningful hemostasis, supporting its use in patients who are poor surgical candidates or who have failed transurethral surgery. Evidence for PAE in refractory hematospermia is limited to small case series and remains investigational. PAE is a safe, guideline-recognized treatment option for BPH that offers meaningful symptom relief with a favorable safety profile, though with less durable outcomes than transurethral surgery. It serves as a clinically valuable salvage or palliative option for refractory prostatic bleeding. Patient selection, shared decision-making with urology and interventional radiology, and realistic counseling about durability are essential to optimizing outcomes.