Is surgery necessary for an enlarged prostate? A patient's guide to prostatic artery embolization (PAE)

An enlarged prostate (benign prostatic hyperplasia, BPH) does not necessarily require surgery.
When symptoms are mild, they can first be controlled with medication. However, for men who find medication provides limited relief and have concerns about instrument-based transurethral surgery, Prostatic Artery Embolization (PAE) offers an alternative that does not involve the urethra or the removal of tissue. The physician inserts a catheter through an artery to selectively block the blood flow supplying the prostate, causing the gland to gradually shrink and symptoms to ease. Suitability must be evaluated by a physician based on prostate volume, blood vessels, and overall condition.

What are the symptoms of an enlarged prostate? When should you see a doctor?

The prostate is located at the bladder outlet, surrounding the urethra. Gradual enlargement of this gland with age is a change most men will experience. Once the gland compresses the urethra, common symptoms include: waking up to urinate two or more times at night, frequent urination during the day, a weak or slow urinary stream, hesitation before beginning to urinate, a feeling of incomplete emptying after urinating, and sudden, strong urges to urinate.

If symptoms have already affected your sleep and daily life, and medication has provided limited relief over time, scheduling a complete evaluation is highly worthwhile. If you experience blood in your urine, recurrent urinary tract infections, or a complete inability to urinate (acute urinary retention), please seek medical attention immediately without delay.

Which department should I visit for an enlarged prostate?

The primary department is Urology, which handles diagnosis, medication, and surgery. PAE, on the other hand, is a catheter-based interventional treatment performed by an interventional radiologist. This is also why many patients have never heard of PAE: it is not performed in a urological operating room, but rather in an angiography suite.

At Sehee Clinic, the Men's Special Clinic is led by Dr. Jiun-Yu Lin, Secretary General of the Taiwan Society of Interventional Radiology. If you are already undergoing follow-ups in urology and wish to explore non-surgical options, you can first complete a preliminary assessment via LINE, and then bring your existing testing reports (PSA, ultrasound, uroflowmetry, etc.) to the clinic for a discussion.

Does an enlarged prostate always require surgery? Treatment actually involves three stages

An enlarged prostate is progressive, but the rate of progression varies from person to person. Management is step-by-step rather than one-size-fits-all:

The first stage involves lifestyle adjustments and medication: reducing fluid and alcohol intake before bed, combined with medications that relax the smooth muscles of the prostate or inhibit glandular growth. Most patients with mild symptoms can remain at this stage.

The second stage is minimally invasive procedures: when medications offer limited effectiveness, cause bothersome side effects (dizziness, impacting sexual function), or when patients prefer not to take medication long-term, options that remove no or minimal tissue—such as PAE or water vapor therapy—can be evaluated.

The third stage is surgery: transurethral resection of the prostate (TURP) or laser surgery, which directly removes the obstructing gland tissue. This provides rapid symptom improvement and is suitable for patients with severe obstruction or those who have developed complications (recurrent infections, bladder stones, or affected kidney function).

Which stage you should stay at and when to move to the next is determined by the severity of symptoms, prostate volume, and overall health status. This is the true value of a complete evaluation.

What is PAE (Prostatic Artery Embolization)?

The principle behind PAE is "cutting off supplies." The prostate relies on the prostatic arteries for its blood supply. The physician inserts a microcatheter through an artery in the wrist or groin. Under image guidance, the physician pinpoints the tiny arterial branches feeding the prostate and injects embolic microspheres to block the blood flow. Due to the reduced blood supply, the gland gradually shrinks, thereby relieving compression on the urethra.

The entire process does not go through the urethra and does not remove any tissue. The wound is only the size of a pinhole, and local anesthesia is used in most cases. PAE at Sehee Clinic is performed in our in-house angiography suite using the GE OEC 3D mobile C-arm (equipped with cone-beam CT functionality) for image guidance. The prostatic arteries are tiny with highly variable branches; 3D cross-sectional localization is key to precise embolization and avoiding surrounding tissues.

Who is suitable for PAE evaluation?

Men under the following circumstances should consider discussing PAE:

Medication therapy is of limited effectiveness, or medication side effects are intolerable; advanced age or cardiovascular comorbidities make general or regional anesthesia risky; concerns about instruments entering through the urethra, or sensitivity to the surgery's impact on sexual function; an excessively large prostate volume (including those over 100 mL) evaluated as unsuitable for traditional transurethral surgery; or professional/personal schedules that cannot accommodate a long recovery period.

Whether you are suitable must still be determined by a physician after inquiring about your history, evaluating imaging, and assessing vascular conditions. PAE is not for everyone; please confirm eligibility before proceeding with treatment.

Who might not be suitable?

Those with poor vascular conditions that might increase the difficulty of catheter navigation, which must be determined by a physician based on imaging; and those with contrast agent allergies or poor kidney function. Before treatment, relevant urological workups, such as a PSA test, must be completed to rule out other urological conditions that require prioritized treatment. All of the above require pre-operative assessment and preparation.

Treatment Process and Recovery Period

Pre-op: Medical history inquiry, ultrasound, blood tests, and relevant imaging (CT/MRI) evaluation to confirm indications and vascular pathways.

Day of Treatment: Performed under local anesthesia via the wrist or groin, taking about 2 hours, during which the patient remains awake and can converse with the physician. Following the procedure, the patient is observed in the recovery area for 2 hours. In most cases, this is an outpatient procedure that does not require hospitalization.

Recovery: Daily activities can be resumed within a few days. It is important to have realistic expectations regarding timing. Symptom improvement from PAE occurs as the gland gradually shrinks, typically appearing progressively between a few weeks to three months, rather than taking effect the next day. This is how the mechanism works, and the physician will explain the expected timeline prior to procedure.

Potential Risks and Post-Operative Care

Over the first few days following treatment, there may be transient frequent urination, burning sensations during urination, or a dull ache in the pelvic area. These are common reactions after embolization and usually resolve on their own. A small number of individuals may experience mild hematuria (blood in urine) or hematospermia (blood in semen). Serious complications are rare, and the physician will provide a comprehensive explanation before the procedure.

After the procedure, please stay hydrated and take medications as directed, and regularly check the wound site on your hand or groin. If you experience a fever, inability to urinate, or significant discomfort, please return to the clinic or contact us immediately.

How are PAE costs calculated?

Sehee's Men's Function and Cardiovascular Health Special Clinic: NT$1,500 for the initial consultation and NT$800 for follow-up consultations, including medical inquiry and basic evaluation.

PAE treatment is a self-pay item. The fee includes the surgical fee, embolization medical devices, image guidance, and post-operative follow-up. The actual cost depends on the evaluation results and the medical devices used, which will be fully explained before treatment. There will be no unexpected post-treatment charges.

Who performs the PAE at Sehee Clinic?

Dr. Jiun-Yu Lin is currently the Director of the Department of Medical Imaging at Taiwan Adventist Hospital, Secretary General of the Taiwan Society of Interventional Radiology, and Chairman of the Vascular and Interventional Radiology Subspecialty of the Radiological Society of the Republic of China. Specializing in catheter-based interventional therapies such as embolization, ablation, and angioplasty, he is the executing physician for PAE and varicocele embolization at Sehee Clinic.
Minimally invasive procedures are completed in our in-house angiography suite equipped with a GE OEC-3D C-arm image guidance system, eliminating the need for referrals to large hospitals.

Frequently Asked Questions

Does an enlarged prostate always require surgery? Not necessarily. When symptoms are mild, they can first be controlled with medication. When medication effectiveness is limited, minimally invasive options like PAE and surgery each have suitable candidates, which are evaluated by a physician based on symptom severity, prostate volume, and overall condition.

Does PAE require hospitalization? How long is the recovery? In most cases, it is performed under local anesthesia without requiring hospitalization, and daily activities can be resumed within a few days. Symptom improvement occurs progressively as the gland shrinks, typically taking several weeks to three months. The physician will explain the expected timeline before the procedure.

Does PAE affect sexual function? Since PAE does not go through the urethra and does not remove tissue, the concern regarding impact on sexual function is relatively low. Individual situations still need to be evaluated and explained by a physician.

Can PAE still be performed if the prostate is over 100 mL? Yes, it can be evaluated. An excessively large prostate that is unsuitable for traditional transurethral surgery is actually one of the indications for PAE. It must be determined by a physician after evaluating vascular conditions.

Where can I get PAE in Taipei?

Sehee Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City.

The procedure is performed by Dr. Jiun-Yu Lin in our in-house angiography suite. We operate entirely on an appointment-only basis. You can complete a preliminary evaluation via LINE or call (02) 2366-0186.

Unsure if you are suitable?

Bring your imaging examination reports and start with a preliminary evaluation via LINE. Confirm whether your condition is suitable for PAE before deciding to visit the clinic.