Risks & Side Effects of Prostate Artery Embolization (PAE)

Medicine Made Simple Summary

Prostate Artery Embolization (PAE) is a minimally invasive procedure that shrinks the prostate by reducing its blood supply. A tiny catheter is inserted through the wrist or groin, and microscopic particles are delivered into the prostate’s arteries. This causes the gland to shrink over time and relieves urinary symptoms. The procedure avoids surgery, avoids general anesthesia, preserves sexual function in most men, and typically has a quick recovery. Complications are uncommon, and most side effects are mild and temporary.

Understanding Risk: Why Patients Ask About Safety

Every medical procedure has risks, even the minimally invasive ones. When men consider PAE for an enlarged prostate, they naturally want to know what side effects might occur, how often they happen, how severe they are, and whether these side effects last. Because PAE avoids cutting or removing tissue, patients often hear that it is “safer than surgery”—and in many ways it is. But understanding the risks clearly helps patients make informed choices.

This article explains the risks of PAE in simple terms. It describes mild, temporary side effects, less common complications, rare issues, and what patients can do to recover smoothly. It also compares PAE risks with those of medications and traditional surgery, helping patients understand where PAE fits in the spectrum of BPH treatments.

Why PAE Has a Low Risk Profile

PAE is minimally invasive. Instead of cutting the prostate, the doctor accesses the arteries through a pinhole-sized opening. No surgical incision is made. No tissue is removed. General anesthesia is not required. The body experiences less trauma, so the complication rate is lower. The risk of bleeding is low, recovery is short, and hospital stay is usually not needed.

The goal is to reduce blood flow to the prostate without affecting other organs. Interventional radiologists use advanced imaging to guide the catheter safely, which keeps risks low.

Common and Expected Side Effects After PAE

Most men experience mild, temporary symptoms as the prostate begins to respond to the reduced blood supply. These are normal signs of healing.

• Pelvic Discomfort: Many men feel a dull ache or fullness in the pelvis for a few days. This occurs because the prostate is undergoing controlled reduction in blood flow. The discomfort is usually mild and responds well to simple pain relievers.
• Frequent Urination: Some men notice increased urinary frequency for a few days as the bladder adjusts. This change is temporary and fades with hydration and rest.
• Burning During Urination: Mild burning or irritation may occur for a short period. This is not a sign of infection. It is the prostate and urinary passage adjusting to internal changes.
• Low-Grade Fever or Fatigue: A slight fever may occur as the body begins the healing process. Fatigue is also common for a few days. Drinking water and resting help relieve these symptoms.
• Blood in Urine or Semen: Some men notice a small amount of blood in urine or semen shortly after the procedure. This usually resolves quickly.
• Temporary Increase in Symptoms: In rare instances, symptoms worsen briefly before improving. This happens as the prostate tissue reacts to reduced blood flow. Improvement follows soon after.

These side effects are expected and usually resolve within days to weeks.

Moderate but Uncommon Side Effects

A small percentage of men experience stronger but still manageable symptoms.

• Urinary Retention: Some men temporarily have difficulty urinating after the procedure. This is uncommon but may require a short-term catheter.
• Prostate Swelling: The prostate may swell slightly before shrinking, causing temporary worsening of symptoms. Anti-inflammatory medications are often helpful.
• Urinary Tract Infection: Infection is uncommon but possible with any urinary procedure. It is treated with antibiotics. Preventive antibiotics are often given before or after PAE.
• Groin or Wrist Hematoma: A small bruise may appear at the catheter insertion site. It usually heals on its own with rest and mild pressure.

Rare but Important Risks to Understand

These risks are rare, but patients should understand them clearly.

• Non-Target Embolization: This occurs when particles accidentally reach nearby tissues instead of staying inside the prostate artery. Interventional radiologists use advanced techniques to minimize this risk. When it happens, symptoms such as pain or inflammation may occur, but serious complications are rare.
• Reduced Blood Flow to the Bladder or Rectum: This is extremely uncommon. Advanced imaging helps prevent this by mapping the blood supply carefully before treatment.
• Severe Infection: A deep infection or abscess is very rare. Early diagnosis and treatment with antibiotics help prevent complications.
• Persistent Pain: A small number of men experience extended pelvic discomfort. It usually resolves with medications.

Most patients never experience these issues, but knowing them helps set realistic expectations.

Risks of PAE Compared With Traditional Surgery

Traditional surgeries such as TURP, laser ablation, or prostate tissue removal involve cutting or vaporizing prostate tissue. Because surgery is more invasive, the risks differ from PAE.

• Higher Risk of Bleeding: Surgery involves cutting tissue, so bleeding is more common. PAE has minimal bleeding risk.
• Retrograde Ejaculation: Surgery often causes semen to flow backward into the bladder. This is permanent for many men. PAE rarely affects ejaculation.
• Longer Recovery: Surgery may require hospital stay, catheter use, and extended recovery time. PAE allows most men to return home the same day.
• Risk of Sexual Dysfunction: Some surgeries affect erectile function. PAE preserves sexual function in most men.
• Higher Risk of Infection: Surgical incisions increase infection risk. PAE uses a tiny puncture, lowering this risk.

Because of these differences, many men choose PAE when they want symptom relief without major surgery.

Risks of PAE Compared With Long-Term Medications

Medications have their own side effects. Alpha-blockers and 5-alpha-reductase inhibitors can cause dizziness, fatigue, low blood pressure, sexual side effects, breast tenderness, and mood changes.

Unlike medications, PAE is a one-time treatment. It avoids lifelong drug use and its cumulative side effects.

How Doctors Reduce Risks Before PAE

Interventional radiologists follow several steps to keep patients safe.

• Detailed Imaging: Ultrasound, MRI, or CT scans map the arteries before the procedure. This helps avoid non-target embolization.
• Antibiotics: Preventive antibiotics reduce infection risk.
• Blood Tests: Blood counts and kidney function are checked before treatment.
• Medication Review: Blood thinners, diabetes medications, and other drugs are reviewed for safety.

These steps ensure the treatment is tailored to each patient’s anatomy and medical history.

How Patients Can Reduce Their Own Risks

Patients also play a role in reducing risks and improving outcomes.

• Stay hydrated
• Follow medication instructions
• Avoid heavy lifting for a few days
• Keep the puncture site clean
• Attend follow-up appointments
• Report unusual symptoms early

Following these steps helps the body heal smoothly.

What to Do if Side Effects Occur

Most side effects improve on their own. But patients should contact their doctor if they experience high fever, worsening pain, inability to urinate, large swelling at the puncture site, or foul-smelling urine. Early treatment prevents complications.

Long-Term Safety of PAE

PAE has been performed for more than a decade worldwide. Long-term studies show that it is safe, effective, and repeatable if necessary. Because the prostate tissue shrinks naturally, the risk of future complications remains low. Many patients enjoy several years of relief after one procedure.

Conclusion

If you are considering PAE and want to understand the risks clearly, schedule a consultation with an interventional radiologist. A personalized evaluation helps you understand which risks apply to you, how to prepare safely, and what results you can expect. Early guidance helps you choose the best treatment for long-term comfort and health.