What is Prostate Artery Embolization (PAE)? Procedure, Cost, Recovery, and Candidacy
What is Prostate Artery Embolization (PAE)? Procedure, Cost, Recovery, and Candidacy
Article Summary
Prostate enlargement does not necessarily require surgery.
When symptoms are mild, they can first be controlled with medication. However, for men who have experienced limited effectiveness with medication and have concerns about transurethral surgery involving instruments, Prostatic Artery Embolization (PAE) is another option that does not go through the urethra and does not remove tissue—a physician inserts a catheter through an artery to selectively block the blood flow supplying the prostate, gradually shrinking the gland and relieving symptoms. Suitability must be evaluated by a physician based on prostate volume, blood vessels, and overall condition.
What are the symptoms of prostate enlargement? When should you see a doctor?
The prostate is located at the bladder outlet, surrounding the urethra, and its gradual enlargement with age is a change most men will experience. After the gland compresses the urethra, common symptoms include: waking up to urinate more than twice a night, frequent urination during the day, a thin or slow urine stream, having to wait a moment to start urinating, a feeling of residual urine after voiding, and sudden, strong urges to urinate.
If symptoms have already affected sleep and daily life, and medication has had limited effectiveness after a period of time, it is worth arranging a complete evaluation. If hematuria, recurrent urinary tract infections, or an absolute inability to urinate (acute urinary retention) occur, please seek medical attention as soon as possible and do not wait.
Which department should I visit for prostate enlargement?
The primary department is Urology, which is responsible for diagnosis, medical treatment, and surgery. PAE, on the other hand, is a catheter-based interventional therapy performed by an interventional radiologist—this is also why many patients have never heard of PAE: it is not performed in the urology operating room, but in the angiography suite.
The Men's Special Clinic at Chyi Medical Clinic is led by Dr. Chun-Yu Lin, Secretary General of the Taiwan Society of Interventional Radiology. If you are already being followed up in urology and want to understand options other than surgery, you can first complete a pre-assessment via LINE and bring your existing test reports (PSA, ultrasound, uroflowmetry, etc.) to the clinic for discussion.
Does prostate enlargement definitely require surgery? Treatment actually has three stages
Prostate enlargement is progressive, but the rate of progression varies from person to person. Treatment is step-by-step and not a one-size-fits-all approach:
The first stage is lifestyle adjustments and medication: reducing fluid and alcohol intake before bedtime, combined with medications that relax the smooth muscle 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 have limited effectiveness, cause bothersome side effects (dizziness, affecting sexual function), or when patients do not want to take medication long-term, options that do not remove or minimally remove tissue, such as PAE or water vapor thermal therapy, can be evaluated.
The third stage is surgery: transurethral resection or laser surgery to directly remove the obstructing gland tissue. This provides rapid symptom improvement and is suitable for patients with severe obstruction or those who have already developed complications (recurrent infections, bladder stones, affected kidney function).
Which stage to stay at and when to move to the next stage is determined by symptom severity, prostate volume, and overall health status—this is the value of a comprehensive evaluation.
What is PAE Prostatic Artery Embolization?
The principle of PAE is "cutting off supplies": the prostate relies on the prostatic arteries for blood supply. A physician inserts a microcatheter through an artery in the wrist or groin and, under imaging guidance, locates the tiny arterial branches supplying the prostate. Embolic microspheres are then injected to block the blood flow. Due to the reduced blood supply, the gland gradually shrinks, thereby relieving the pressure 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. Chyi Medical's PAE is completed in our angiography operating suite, using the GE OEC 3D mobile C-arm (with cone-beam CT functionality) for imaging guidance. Since prostatic arteries are tiny and have many anatomical variations, 3D tomographic localization is the key to precise embolization and avoiding surrounding tissues.
Who is suitable for PAE evaluation?
Men in the following situations should consider including PAE in their discussions:
Limited effectiveness of medical treatment or inability to tolerate medication side effects; advanced age or cardiovascular comorbidities where general or spinal anesthesia presents high risks; concerns about instruments entering through the urethra or worry about the impact of surgery on sexual function; an excessively large prostate volume (including over 100 mL) evaluated as unsuitable for traditional transurethral surgery; or work and lifestyle conditions that cannot accommodate a long recovery period.
Whether it is suitable must still be determined by a physician after consultation, imaging, and vascular condition evaluation—PAE is not suitable for everyone; confirm before treating.
Who might not be suitable?
Those with poor vascular conditions that may increase the difficulty of catheter manipulation, which must be judged by a physician based on imaging; those with contrast media allergies or poor kidney function. Prior to treatment, relevant urological examinations such as PSA must be completed to rule out other urological diseases that require priority management. The above require pre-operative evaluation and preparation.
Treatment Process and Recovery Period
Pre-operative: Consultation, ultrasound, blood tests, and relevant imaging (CT/MRI) evaluation to confirm indications and vascular access 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. After completion, the patient is observed in the recovery area for 2 hours. In most cases, outpatient surgery does not require hospitalization.
Recovery: Daily activities can be resumed within a few days. It is important to have correct expectations regarding time—symptom improvement from PAE occurs as the gland gradually shrinks, typically appearing progressively between a few weeks to three months, rather than overnight. This is due to the mechanism of action, and the physician will explain the expected timeline before the procedure.
Is there international medical evidence for PAE?
Yes, and it has already reached the stage where "international societies have established standards of practice." The Society of Interventional Radiology (SIR) released the latest practice guidance document for PAE in 2026, outlining patient selection, technical, and care standards; this guidance updates the multi-society consensus position statement jointly released in 2019 by SIR, the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and other international societies. CIRSE also established standards of practice for PAE in 2020. The American Urological Association (AUA) has also included PAE as one of the treatment options for benign prostatic hyperplasia.
Regarding evidence of efficacy, a randomized controlled trial published in "European Urology" in 2020 used a "sham procedure" as a control group, proving that the symptom improvement of PAE is not a placebo effect; the 2023 PARTEM multicenter phase 3 study showed that for patients with limited control on medication, PAE provided superior symptom improvement compared to continued combination medical therapy. Direct comparisons with transurethral resection of the prostate (TURP), including randomized trials with 5-year follow-up, show that both can improve symptoms. TURP typically achieves greater improvements in objective indicators such as urinary flow rate and post-void residual volume, while the advantages of PAE lie in being non-transurethral, minimally invasive, and having a shorter recovery. Long-term follow-up also notes that the probability of requiring retreatment after PAE is higher than after TURP, which we will explain truthfully before treatment.
What are the disadvantages and risks of PAE? What should I pay attention to after the procedure?
Within a few days after treatment, transient frequent urination, burning sensation during urination, and a dull, bloated feeling in the pelvic area may occur. These are common reactions after embolization and usually resolve on their own; a small number of people may experience mild hematuria or hematospermia. Serious complications are uncommon, and the physician will explain them fully before the procedure.
After the procedure, please follow instructions to replenish fluids and take medications, and regularly inspect the wound on your wrist or groin; if fever, inability to urinate, or significant discomfort occurs, please return to the clinic or contact us as soon as possible.
How are PAE costs calculated?
Chyi Medical's Men's Function and Cardiovascular Health Special Clinic: Initial consultation is NT$1,500, follow-up consultation is NT$800, including consultation and basic evaluation.
PAE treatment is a self-pay item. The fee includes the surgical fee, embolic medical devices, imaging guidance, and post-operative follow-up. The actual cost depends on the evaluation results and the medical devices used, which will be fully explained prior to treatment, with no unexpected fees arising after treatment.
Who performs PAE at Chyi Medical?
Dr. Chun-Yu Lin - Currently Director of the Department of Medical Imaging at Adventist Hospital, Secretary General of the Taiwan Society of Interventional Radiology, and Chairman of the Vascular and Interventional Radiology Subspecialty of the Taiwan Radiological Society. He specializes in catheter-based interventional therapies such as embolization, ablation, and angioplasty, and is the performing physician for PAE and varicocele embolization at Chyi Medical Clinic.
Minimally invasive procedures are completed in our angiography operating suite, which is equipped with a GE OEC-3D C-arm imaging guidance system, eliminating the need for referral to large hospitals.
Frequently Asked Questions
Does prostate enlargement definitely require surgery? Not necessarily. Mild symptoms can first be controlled with medication. When medication effectiveness is limited, minimally invasive options like PAE and surgery each have suitable candidates, evaluated by a physician based on symptom severity, prostate volume, and overall condition. For a complete guide on how to decide, please see "Does Prostate Enlargement Definitely Require Surgery? When Can You Hold Off, and When Should You Consider Surgery?".
Does PAE require hospitalization? How long is the recovery period? In most cases, it is performed under local anesthesia without the need for hospitalization, and daily activities can be resumed within a few days. Symptom improvement appears progressively as the gland shrinks, typically within a few 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, concerns regarding its impact on sexual function are 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. Prostates of excessive volume that are unsuitable for traditional transurethral surgery are precisely one of the indications for PAE, which must be determined by a physician after confirming vascular conditions.
Where can I undergo PAE in Taipei?
Chyi Medical Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City,
performed by Dr. Chun-Yu Lin in our angiography operating suite. By appointment only; you can initiate a pre-assessment via LINE or call (02) 2366-0186.
Unsure if you are suitable?
Bring your imaging test reports and start with a pre-assessment via LINE - first confirm if your condition is suitable for PAE, then decide whether to visit the clinic.
Authoring Physician: Dr. Chun-Yu Lin
Last Updated: August 10, 2026
Disclaimer: This article is for health education purposes only and cannot replace professional medical diagnosis and treatment advice. The suitability of any treatment must be evaluated and decided by a physician.
International Medical Literature References for Prostatic Artery Embolization (PAE):
Mouli S, Dolmatch BL, Gunn AJ, et al. Society of Interventional Radiology (SIR) 2026 practice guidance document for prostatic artery embolization. J Vasc Interv Radiol. 2026;108771. doi:10.1016/j.jvir.2026.108771
McWilliams JP, Bilhim TA, Carnevale FC, et al. Society of Interventional Radiology multisociety consensus position statement on prostatic artery embolization for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia. J Vasc Interv Radiol. 2019;30(5):627-637.e1.
Cornelis FH, Bilhim T, Hacking N, et al. CIRSE standards of practice on prostatic artery embolisation. Cardiovasc Intervent Radiol. 2020;43(2):176-185.
Pisco JM, Bilhim T, Costa NV, et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol. 2020;77(3):354-362. doi:10.1016/j.eururo.2019.11.010
Sapoval M, Thiounn N, Descazeaud A, et al. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3 superiority trial. Lancet Reg Health Eur. 2023;31:100672. doi:10.1016/j.lanepe.2023.100672
Müllhaupt G, Hechelhammer L, Diener PA, et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic obstruction: 5-year outcomes of a randomised trial. Eur Urol Focus. 2024;10(5):788-795.
