Prostate artery embolisation (PAE)
A minimally invasive procedure in which an interventional radiologist blocks some of the small arteries supplying an enlarged prostate, through a tiny puncture in the groin or wrist, to ease urinary symptoms.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- PAE shrinks an enlarged prostate by blocking some of its blood supply, to ease urinary symptoms — it is an alternative to surgery for some men, not a guaranteed cure.
- It is minimally invasive, through a tiny groin or wrist puncture, with no surgical cut into the prostate and no surgical scar.
- It tends to protect sexual function better than some prostate operations, but it is newer, may work less completely than surgery, and symptoms can return.
- UK guidance says you should be assessed jointly by a urologist and an interventional radiologist; not everyone is suitable.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your radiologist will give you advice for your situation.
Can improve urinary symptoms and quality of life from an enlarged prostate
Your symptoms have a cause other than benign prostate enlargement, or prostate cancer has not been properly considered.
You rest while the puncture site seals. With groin access you lie flat for a few hours; with wrist access you can usually move sooner. Pelvic discomfort...
Joint follow-up involving both the interventional radiologist and the urologist.
You rest while the puncture site seals. With groin access you lie flat for a few hours; with wrist access you can...
Some men get 'post-PAE syndrome' — pelvic or perineal aching, a frequent urge to pass urine, and sometimes a...
Most men return to light activity and often work within about a week, avoiding heavy lifting and strenuous...
Urinary symptoms typically improve gradually over this period as the prostate shrinks and softens. Some men notice...
What is prostate artery embolisation (PAE)?
Prostate artery embolisation (PAE) is a treatment for an enlarged prostate (benign prostatic hyperplasia) that is causing bothersome urinary symptoms — such as a weak stream, going often, getting up at night, or difficulty emptying the bladder. It does not remove prostate tissue. Instead, an interventional radiologist injects tiny particles into the small arteries that feed the prostate, reducing its blood supply so it shrinks and softens, which can ease the symptoms.
It is done through a tiny puncture in an artery in the groin or wrist, using X-ray guidance to steer a fine tube (catheter) to the prostate's arteries. Because there is only a small skin puncture, under local anaesthetic and often light sedation, it is described as minimally invasive: there is no surgical cut into the prostate and no surgical scar.
PAE is best understood as an alternative to prostate surgery for some men — particularly those who want to avoid an operation or a general anaesthetic, or who are keen to protect sexual function. It is not the right choice for everyone, and it is newer and less established than standard surgery such as TURP. UK guidance says it should only be offered after a urologist and an interventional radiologist have assessed you together.
It aims to improve symptoms and quality of life, not to guarantee a cure. Not all men respond, the prostate can grow again over time, and further treatment is sometimes needed. Honest discussion of how likely it is to help you, and how it compares with surgery and medicines, is essential.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
PAE vs TURP (standard prostate surgery)
| Point | PAE | TURP |
|---|---|---|
| Approach | Tiny artery puncture | Through the urethra |
| Anaesthetic | Local ± sedation | Spinal or general |
| Effect on flow | Improves; may be less complete | Usually strong improvement |
| Sexual side effects | Lower risk of dry orgasm | Higher risk of dry orgasm |
| Track record | Newer, less long-term data | Long-established |
TURP generally gives a stronger, well-proven improvement in flow; PAE avoids an operation and tends to protect ejaculation. Your urologist and interventional radiologist will help you weigh this up.
Preparing for your procedure
- You should be assessed jointly by a urologist and an interventional radiologist, with tests of your symptoms, flow and prostate size, and your prostate-cancer risk considered.
- Tell the team about all medicines, especially blood thinners, which may need pausing.
- Mention any allergy to X-ray dye (contrast) and any kidney problems, as contrast is used.
- Discuss honestly what you most want — for example avoiding surgery, or protecting sexual function — and how likely PAE is to deliver it for you.
- Ask about the chance of needing further treatment, including surgery, later on.
- Arrange for someone to take you home and, if you have a day-case procedure, to stay with you that night.
- Plan around a week of taking it easy, depending on your job.
What happens
You lie on an X-ray table. The skin over the artery in your groin or wrist is cleaned and numbed with local anaesthetic, and you may be given light sedation to help you relax.
The interventional radiologist makes a tiny puncture into the artery and threads a fine tube (catheter) through the blood vessels, using X-ray guidance and a small amount of contrast dye to find the arteries supplying the prostate. Tiny particles are then injected to block these small vessels and reduce the prostate's blood supply. Both sides are usually treated.
You should not feel the particles going in, though some men get pelvic discomfort or a feeling of needing to pass urine. When finished, the catheter is removed and pressure or a small closure device seals the puncture. There is a small skin puncture rather than a surgical cut, so there is no surgical scar. The procedure usually takes one to three hours, and most men go home the same day or after one night.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Your symptoms have a cause other than benign prostate enlargement, or prostate cancer has not been properly considered.
- Your prostate arteries are too narrow, diseased or unusual to treat safely.
- You have an untreated urinary infection or another condition that should be dealt with first.
- You have a bleeding tendency, severe contrast allergy or significant kidney problems that make the procedure unsafe.
- You want the strongest, most certain improvement in flow, where surgery may suit you better.
Delay or rearrange if…
- You have a current urinary or other infection.
- Your blood thinners or a clotting problem have not yet been reviewed.
- Prostate cancer or another cause of your symptoms has not been excluded.
- Your kidney function or a contrast allergy needs checking before contrast is used.
- You have not yet had a joint assessment by a urologist and an interventional radiologist.
Alternatives to discuss
- Medicines for an enlarged prostate (such as alpha-blockers or 5-alpha-reductase inhibitors).
- TURP or other prostate operations, which generally give a stronger, well-proven improvement in flow.
- Newer procedures for an enlarged prostate, where suitable and available.
- Watchful waiting and lifestyle measures if symptoms are mild.
- A long-term catheter in men who are not suitable for any procedure.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Can improve urinary symptoms and quality of life from an enlarged prostate
- Minimally invasive, through a tiny puncture, with no surgical cut into the prostate
- Usually done under local anaesthetic with sedation, avoiding a general anaesthetic for many men
- Lower risk of 'dry orgasm' (retrograde ejaculation) than some prostate operations
- May suit men who want to avoid surgery, are less fit for an operation, or have a very large prostate
- Quicker return to normal activity than many surgical options for some men
Risks & complications
- Pelvic or perineal discomfort, cramping or a frequent urge to pass urine for a few days ('post-PAE syndrome')
- A small amount of blood in the urine, semen or, occasionally, stools, which usually settles
- Bruising or soreness at the groin or wrist puncture site
- Temporary worsening of urinary symptoms or burning when passing urine soon afterwards
- Symptoms not improving enough, so further treatment is needed
- Difficulty passing urine needing a temporary catheter
- Urinary infection
- The procedure not being technically possible because of narrow or unusual arteries
- Non-target embolisation — particles reaching the bladder, bowel or penis, which can cause blood in the urine or stools, or small ulcers, usually settling but occasionally serious
- Damage to the artery at the puncture site
- Serious infection
- Effects on sexual or erectile function
The most PAE-specific concern is non-target embolisation, where particles reach the bladder, bowel or penis; this is uncommon and usually settles, but it is why the procedure should be done by an experienced interventional radiologist. Many men get a short spell of pelvic discomfort and urinary symptoms afterwards. Because PAE is newer than surgery, ask your team for honest figures on how likely it is to help you, the chance of needing further treatment, and how it compares with TURP and with medicines.
Published figures to discuss
PAE is newer than standard prostate surgery, so long-term results are less established and figures vary between centres and studies. Most men improve, but the degree of benefit, the chance of needing further treatment and the risk of complications such as non-target embolisation depend on anatomy and operator experience.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Symptom improvement after PAE | A majority of men improve in published series (commonly reported around 70% or more) | Improvement in flow may be less complete than after TURP; figures vary by study and follow-up length. | NICE — Prostate artery embolisation for LUTS caused by BPH (IPG611)nice.org.ukPublished figure |
| Retrograde ejaculation ('dry orgasm') | Reported in under around 15% in UK centres, much lower than TURP (reported up to around 48%) | Protecting ejaculation is one reason some men choose PAE over surgery. | NICE — Prostate artery embolisation for LUTS caused by BPH (IPG611)nice.org.ukPublished figure |
| Non-target embolisation | Uncommon; rates vary and depend on anatomy and operator experience | Particles reaching the bladder, bowel or penis; usually settles but occasionally serious. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery is usually quicker than after prostate surgery. Many men have some pelvic discomfort and urinary symptoms for a few days, then improve gradually over weeks as the prostate settles and shrinks.
- Pelvic or perineal aching and a frequent urge to pass urine for a few days
- A small amount of blood in the urine or semen that settles
- Bruising or soreness at the groin or wrist puncture
- Gradual rather than instant improvement in urinary symptoms
- Tiredness for a few days after the procedure
Aftercare
- Rest as advised, especially in the first day or two, and avoid heavy lifting and strenuous exercise at first.
- Drink plenty of fluids and use simple pain relief for pelvic discomfort.
- Look after the puncture site; keep it clean and dry and watch for swelling or bleeding.
- Expect, and do not be alarmed by, a little blood in the urine or semen in the first days, but report heavy bleeding.
- Take any prescribed medicines, such as anti-inflammatories or antibiotics, as directed.
- Restart blood thinners only when the team advises.
- Keep your review appointment to check how well symptoms have improved.
- Lift home and someone to stay with you arranged
- Simple pain relief and any prescribed medicines collected
- When to restart blood thinners confirmed
- About a week of taking it easy planned around work
- List of urgent warning signs saved
- A review appointment booked
- Clinic or out-of-hours contact number saved
Scars and how they heal
PAE is done through a tiny puncture in an artery in the groin or wrist, not a surgical cut, so it does not leave a surgical scar. There may be some bruising or soreness at the puncture site, and occasionally a small lump or area of bruising that settles over a week or two.
⚠ Get urgent help if…
- Being unable to pass urine at all (urinary retention) — seek urgent help
- Heavy bleeding in the urine, or passing clots, rather than a small amount that settles
- Severe or worsening pelvic, abdominal or rectal pain
- Fever, chills or feeling very unwell (possible infection)
- A cold, painful, pale or numb leg or hand, or a swelling at the puncture site (possible artery problem) — seek urgent help
- Pain or ulcers at the tip of the penis, or blood in the stools that does not settle
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your radiologist gives you.
Results & realistic expectations
A good result is a meaningful improvement in urinary symptoms and quality of life, usually building over weeks to a few months as the prostate shrinks. In studies, a majority of men notice improvement, but PAE does not remove tissue and the improvement in flow may be less complete than after an operation such as TURP.
PAE is not a guaranteed cure. Some men do not respond well, the prostate can enlarge again over time, and a proportion of men need further treatment, including medicines or surgery, later on. Because the evidence base is still building compared with established surgery, your team should be honest about the uncertainty and about what to expect in your particular case.
Many men maintain improved symptoms for years after PAE, but the prostate can grow again and symptoms can return over time. Long-term results are less well established than for standard surgery, and some men go on to need medicines or an operation later. Your urologist will usually keep your prostate health under review.
Related tests, treatments or support
PAE is one option among several for an enlarged prostate, alongside medicines and various operations. The choice is made together with a urologist, who will also have considered and, where appropriate, ruled out prostate cancer. Some men try medicines first; others choose between PAE and surgery depending on their priorities, fitness and prostate size.
Follow-up & long-term care
You will usually be reviewed after the procedure to assess how much your symptoms and urinary flow have improved, often with questionnaires and flow tests, and to plan any further treatment if needed. Your urologist generally remains involved in your ongoing prostate care. You should know who to contact if you have problems such as being unable to pass urine, heavy bleeding or signs of infection.
- Attend reviews so symptom improvement and any regrowth can be monitored
- Continue any prostate medicines if advised, and discuss stopping them with your urologist
- Keep up general prostate-health checks as recommended
- Report returning urinary symptoms early so options can be reviewed
Repeat, follow-on and what comes next
- Symptoms can return as the prostate regrows, and some men need further treatment over time.
- A proportion of men go on to have medicines or surgery such as TURP after PAE.
- Occasionally the procedure cannot be completed because of unsuitable arteries, and another treatment is needed.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Joint follow-up involving both the interventional radiologist and the urologist.
- A clear review with symptom questionnaires and flow tests to judge benefit.
- Honest discussion of next steps if symptoms persist or return, including surgery.
- Written advice on post-PAE symptoms, puncture-site care and warning signs.
- An urgent-care route for retention, heavy bleeding or signs of infection.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The interventional radiologist's fee and the imaging-suite (angiography) facility fee
- Joint assessment by a urologist and an interventional radiologist beforehand
- Tests such as flow studies, prostate imaging and blood tests
- Any sedation and the embolisation particles and equipment used
- Whether the procedure is a day case or includes an overnight stay
- Follow-up reviews and any further treatment if symptoms persist or return
- The interventional radiologist's fee and who performs the procedure
- The angiography-suite/facility fee and any overnight stay
- The cost of the joint urology and radiology assessment and pre-procedure tests
- Sedation, contrast and embolisation materials
- Follow-up reviews to assess your response
- What happens, and what it costs, if you need further treatment or surgery later
- The cancellation policy and cover if a complication occurs
On the NHS? PAE is available on the NHS in some centres under proper governance and after joint assessment by a urologist and interventional radiologist; availability varies, and some men consider it privately.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being offered PAE without joint assessment by a urologist and an interventional radiologist.
- Prostate cancer not being properly considered before treatment.
- Being given the impression PAE is a guaranteed cure or always as effective as surgery.
- No honest discussion of the chance of needing further treatment later.
- No clear warning about non-target embolisation or 'post-PAE syndrome'.
Marketing red flags
- Promoting PAE as a 'cure' for an enlarged prostate.
- Claiming it is always better than, or just as effective as, surgery.
- Describing it as completely 'without risks' or 'scarless surgery'.
- Not mentioning that it is newer with less long-term evidence.
- Offering it without involving a urologist or excluding prostate cancer.
Choosing a specialist safely
- Check the radiologist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the radiologist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good radiologist will welcome every one of these.
- Have a urologist and interventional radiologist both assessed me, and do they agree PAE is reasonable for me?
- How likely is PAE to improve my symptoms, and how does that compare with TURP or medicines?
- What is the chance I will need further treatment, including surgery, later?
- What are the specific risks for me, including non-target embolisation?
- How has prostate cancer been considered or excluded in my case?
- How many PAE procedures does this team do, and what are their results?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the radiologist who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is PAE an operation?
Is it as good as a prostate operation like TURP?
Will it affect my sex life?
Who is it suitable for?
How soon will I notice a difference?
Can I get PAE on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE — Prostate artery embolisation for LUTS caused by BPH (IPG611) NICE — PAE information for the public BSIR — Prostate artery embolisation (patient leaflet) UCLH NHS — Prostate artery embolisation (PAE) CIRSE — Prostatic artery embolisation (PAE) patient information
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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