By Dr. Shivank Bhatia, M.D. FSIR
Interventional Radiologist, Founder of Florida Prostate Centers® and Naples Prostate Center®
Benign Prostatic Hyperplasia (BPH), a noncancerous enlargement of the prostate gland, affects approximately 50% of men over age 50 and up to 90% over age 80. The resultant lower urinary tract symptoms (LUTS)—including urinary frequency, urgency, nocturia, weak stream, and incomplete bladder emptying or Urinary Retention — can significantly diminish quality of life. Traditionally, management options have included pharmacotherapy and surgical interventions such as transurethral resection of the prostate (TURP). However, for many patients, particularly those with comorbidities or aversion to surgical risks, Prostate Artery Embolization (PAE) has emerged as a safe, effective, and durable minimally invasive alternative.
What is PAE?
Prostate Artery Embolization is a catheter-based endovascular procedure performed under conscious sedation. It involves selective catheterization of the arteries supplying the prostate followed by embolization—controlled blockage—of these vessels using calibrated microspheres. The occlusion reduces blood flow, inducing ischemia in hyperplastic prostatic tissue. Over time, this leads to volume reduction and symptomatic improvement.
Patient Selection and Pre-Procedural Considerations
Optimal candidates are typically men with moderate to severe LUTS due to BPH who wish to preserve their ejaculation, sexual function or prefer a minimally invasive option. PAE is a size independent option – it serves patients with both moderate (<80cc) and large prostates ( >80 cc), where traditional surgery carries higher complication risks and options are limited.
Evaluation includes detailed urologic history, physical examination, International Prostate Symptom Score (IPSS) assessment, Prostate Specific Antigen (PSA) level and imaging—most commonly a pelvic MRI or ultrasound—to evaluate the health of prostate and bladder. A collaborative approach with urologists ensures comprehensive care and proper diagnosis.
The PAE Procedure
PAE begins with percutaneous arterial access—usually via the femoral artery (groin access) using image-guided fluoroscopy. Through a microcatheter, the interventional radiologist navigates into the prostatic arteries bilaterally. Embolic microspheres (typically 300–500 µm in size) are then injected until stasis is achieved.
Technical challenges include arterial tortuosity and variability in pelvic vascular anatomy. However, advancements in microcatheter technology, experienced operators and imaging have improved success rates. In the hands of experienced operators like those at Naples Prostate Center®, bilateral embolization is achievable in over 97% of cases.
Clinical Outcomes and Efficacy
A Cochrane review comparing PAE to TURP based on up to 24 months’ follow-up, showed that PAE and TURP may work similarly well in helping to relieve symptoms. Men’s quality of life may be also improved similarly.
Long-term outcomes of PAE are favorable. Our study of 1075 PAE patients – the largest in the US – published in the prestigious, Peer-Reviewed Journal – showed sustained symptom relief at three to five years post-PAE in over 84% of patients. Importantly, PAE preserves sexual function—an often under-recognized concern with surgical options like TURP or laser ablation, which carry risks of retrograde ejaculation and erectile dysfunction.
Safety Profile and Complications
PAE has a strong safety profile. Minor complications, such as transient urinary discomfort, and bladder spams typically resolve within few days and are managed by over the counter medications. Major complications are rare (<1%), especially in experienced hands. The non-surgical nature of the procedure allows it to be performed without need for anesthesia, avoiding systemic risks. This safety profile, minimally invasive nature and preservation of sexual function make PAE a preferred option for most men.
Advantages of PAE in the Modern Therapeutic Landscape
In the context of modern value-based care, PAE stands out for several reasons:
1. Minimally-Invasive – No incisions, no general anesthesia.
2. Outpatient Procedure – Typically performed in under an hour, with same-day discharge.
3. Lower Risk Profile – Reduced risk of bleeding, infection, or incontinence.
4. Preservation of Sexual Function – A significant factor for many men.
5. Durability of Results – Sustained symptom improvement with a low reintervention rate.
Conclusion: With personal experience of over 1800 PAE procedures, I am an advocate for patient-centred, minimally invasive therapies, I have witnessed firsthand the transformative impact PAE can have on patients suffering from BPH. For residents of Collier and Lee counties, access to this advanced treatment offers new hope—particularly for those seeking alternatives to traditional surgery.
While no treatment is universally appropriate, PAE provides a compelling option in the evolving algorithm for BPH management. We ensure that patients receive the most appropriate and individualized care.
About the Author:
Shivank Bhatia, M.D. FSIR, is a board-certified interventional radiologist and founder of Florida Prostate Centers. He served as Chariman and Professor of Interventional Radiology at UHealth – University of Miami Health System from 2019 – March 2025.
Dr. Shivank Bhatia is an internationally renowned for his expertise in minimally invasive image-guided therapies that can treat various common medical conditions.
Dr. Bhatia’s career highlights include:
• Performed over 1800 PAE procedures – one of the largest in United States
• Pioneered prostate artery embolization in the U.S.
• Served as a PI on 3 clinical trials related to PAE
• Published the largest series of 1075 PAE patients to date in U.S
• Led an FDA approved Investigational Device Exemption (IDE) study for investigating the effects of GAE (Geniculate Artery Embolization) for knee osteoarthritis.
• Awarded Fellow of Society of Interventional Radiology, January 2020
• Delivered more than 100 invited lectures and published dozens of scientific articles in peer-reviewed journals on the topic of interventional radiology
• Trained more than 400 physicians on techniques related to prostate artery embolization
With a strong background in radiology and advanced training in interventional techniques, Dr. Bhatia has dedicated his career to improving patient outcomes through innovative approaches. Dr. Bhatia has contributed significantly to advancing literature supporting the adoption of PAE as a standard of care for BPH (enlarged prostate).
Jung et al: PAE for the treatment of LUTS in men with BPH. Cochrane Database of Systematic Reviews 2022, Issue 3. Art. No.: CD012867.
NAPLES PROSTATE CENTER
1875 Veterans Park Dr. Suite 2203
Naples, FL 34109
239-387-2099 | www.FloridaProstateCenters.com