Prostate artery embolization, or PAE, treats an enlarged prostate by cutting off part of its blood supply. An interventional radiologist threads a thin catheter through an artery in the wrist or groin to the small arteries feeding the prostate, then releases tiny particles that block them. Starved of blood, the gland shrinks over the following weeks and months, the pressure on the urethra eases, and the stream improves. Nothing is cut, nothing is removed, and there is no instrument in the urethra.
At NYMD Center, PAE is one of two minimally invasive treatments we favor for benign prostatic hyperplasia (BPH), and which one we recommend depends mostly on the size of your prostate. For smaller glands, under about 35 grams, we usually recommend Rezūm, a water vapor treatment done through the urethra in the office. For glands larger than that, we recommend PAE. We prefer it over laser TURP and aquablation for larger prostates because it is less invasive, usually requires no catheter afterward, and carries fewer complications, in particular a much lower risk of the retrograde ejaculation, bleeding and incontinence that can follow surgery through the urethra.
PAE is a team procedure here. The urologist makes the diagnosis, confirms that the prostate is the cause of your symptoms, decides whether you are a candidate, and manages your recovery. The embolization itself is performed by Dr. Yosef Golowa, our fellowship-trained interventional radiologist. Together the team has performed more than a thousand cases. We built our interventional radiology program in 2021 specifically around this procedure, and it remains the most common embolization we do.
Who it affects and the symptoms that bring people in
BPH is nearly universal in aging men. The prostate keeps growing throughout adult life, and by the sixties most men have some enlargement. Whether it causes trouble depends on how the gland grows and how much it squeezes the urethra passing through it.
The symptoms that bring men in are familiar: a weak or hesitant stream, straining, stopping and starting, dribbling at the end, a feeling of not emptying, needing to go often, urgency, and getting up several times a night. Men with larger prostates are also more likely to have episodes of bleeding, repeated urinary infections, or acute retention, where they suddenly cannot urinate at all and need a catheter.
There is a reason not to wait. When the bladder has to push against an obstruction for years, its muscle wall thickens and then overstretches. Eventually a chronically overfilled bladder stops contracting properly, and at that point relieving the obstruction may not restore normal emptying. This decompensation can be permanent. Treating the obstruction while the bladder still has good function is what preserves the result.
How we evaluate it at NYMD Center
Every man is evaluated by a urologist before any PAE is considered. The first visit includes a symptom questionnaire, a uroflow study that measures your flow rate, pattern and voided volume, a bladder scan for post-void residual, and a urine dip with culture if indicated. Blood work includes a PSA. We image the prostate with ultrasound to measure its volume, since size drives the treatment recommendation, and we check the kidneys for any back-pressure.
When the picture is unclear, or when there is blood in the urine, we perform a cystoscopy in the office, which takes a few minutes with local anesthetic gel and lets us see the prostate, the bladder neck and the bladder directly. Urodynamic testing is added when we need to be sure the bladder itself is still contracting well, which matters for predicting how much a procedure will help.
If the PSA is elevated for the size of the gland, cancer has to be excluded first, and we may use the ExoDx prostate test or an MRI before proceeding. Before PAE, Dr. Golowa reviews a CT angiogram of the pelvis to map the prostatic arteries and plan the approach.
Treatment options
Watchful waiting and medication
Mild symptoms that do not bother you can be watched. Alpha-blockers relax the muscle at the bladder neck and help the stream within days, though they can cause dizziness and affect ejaculation. 5-alpha-reductase inhibitors shrink the gland slowly over months and have sexual side effects for some men. Medications treat the symptom rather than the growth, and many men stop them or outgrow them.
Rezūm water vapor therapy
For prostates under roughly 35 grams, Rezūm delivers a few seconds of steam into the tissue through a small device in the urethra. The treated tissue is reabsorbed over weeks. It is done in the office and preserves sexual function well. Most men need a catheter for a few days, and urinary symptoms are typically worse before they improve. It is not well suited to large glands or a large middle lobe.
Prostate artery embolization
For prostates above that size, PAE is our preferred option. It is done in a single session under sedation, through a pinhole in the wrist or groin. You go home the same day, usually without a catheter. Improvement builds over several weeks as the gland shrinks. Because the urethra is untouched, ejaculation and continence are preserved in the great majority of men. Side effects are mostly mild and short-lived: pelvic discomfort, a few days of burning or frequency, and occasionally a small amount of blood in the urine or semen. Not every man's arterial anatomy allows embolization, which is what the planning CT tells us.
Surgery through the urethra
Laser TURP, HoLEP and aquablation remove or ablate tissue directly and produce a strong improvement in flow. They require anesthesia, a catheter, often an overnight stay, and carry meaningful rates of retrograde ejaculation and bleeding, with a smaller risk of incontinence. We reserve them for men whose anatomy is unsuitable for embolization, whose bladder has already begun to decompensate and needs a maximal result, or who have not responded to PAE.
What to expect at your visit
Your first appointment is with a urologist and includes the office testing above; most of it is finished the same day. If PAE looks right for you, we arrange the planning CT and a consultation with Dr. Golowa. The procedure itself takes one to two hours. You will have a small dressing at the access site, spend a short time in recovery, and go home with a companion. Most men are back to desk work within a couple of days. The urologist sees you in follow-up to track your flow and residual as the gland shrinks. Our full guide to the procedure is at 1prostate.com.
When to seek care urgently
If you cannot urinate at all, or you have fever and chills with urinary symptoms, go to an emergency department or call us the same day. Painless blood in the urine is not an emergency but always needs evaluation.
Questions patients ask
How do you decide between Rezūm and PAE?
Mostly by prostate size, measured on ultrasound. Glands under about 35 grams do well with Rezūm water vapor treatment in the office. Larger glands respond better to embolization, which shrinks the whole gland rather than a section of it. Symptoms, bladder function, medical history and your own priorities around sexual function and recovery also factor in.
Will I need a catheter after PAE?
Usually not. Because nothing is done inside the urethra, most men urinate on their own immediately after the procedure and go home the same day without a catheter. This is one of the main reasons we prefer PAE over laser TURP or aquablation for larger prostates, both of which require a catheter afterward.
Does PAE affect erections or ejaculation?
In the great majority of men, no. Retrograde ejaculation is common after surgery through the urethra because the bladder neck is cut; PAE leaves it intact. Erectile function is generally unchanged. Some men notice a small amount of blood in the semen for a few weeks as the gland shrinks.
How soon will I notice improvement?
PAE works by shrinking the prostate gradually, so the stream improves over several weeks rather than overnight. Most men notice a difference within the first month and continue to improve over about three months. Your urologist tracks progress with flow studies and bladder scans at follow-up visits.
Why is a urologist involved if a radiologist does the procedure?
Because the diagnosis comes first. Urinary symptoms have many causes, and embolizing a prostate that is not the problem helps no one. The urologist confirms the obstruction, rules out cancer, checks bladder function, decides whether you are a candidate, and manages your recovery. Dr. Golowa performs the embolization itself. That division is what makes the results reliable.
What if PAE does not work for me?
Most men improve, but a minority need more. Embolization does not close any doors: Rezūm, laser TURP, HoLEP or aquablation remain available afterward, and the urologist who evaluated you will guide that decision. In some men the arterial anatomy on the planning CT tells us in advance that embolization is not a good option, and we say so.
Make an appointment
Manhattan (212) 991-9991 · Forest Hills (718) 360-9550 · same-week visits, most major insurance accepted.