Benign prostatic hyperplasia — an enlarged prostate — is one of the most common conditions men face after 50. It brings a weak stream, frequent urination, and waking through the night. For decades the answer was surgery that cut or removed prostate tissue, often with a hospital stay and real trade-offs.
Prostate Artery Embolization (PAE) takes a different path. Through a tiny catheter, the blood supply feeding the enlarged prostate is reduced — and the gland shrinks from the inside. There is no surgical cutting of the prostate, and the procedure is typically completed in under an hour, in the office.
In one case, a patient arrived with a 210cc prostate and severe urinary retention, told elsewhere that open surgery and a 4–5 day hospital stay were his only option. PAE was performed in under an hour. Three months later his prostate had shrunk by nearly 50%, his catheter was gone, and his flow was strong.
The prostate is never cut or removed — its blood supply is simply reduced so it shrinks naturally.
PAE is designed to relieve obstruction while preserving urinary and sexual function.
Most patients go home the same day and return to normal life quickly — no multi-day hospital stay.
PAE is performed through a tiny pinhole, using imaging to guide every step. There is no incision and no general anesthesia.
Through a pinhole in the wrist or groin, a thin catheter is guided to the arteries feeding the prostate. Live imaging maps the exact vessels involved — this precision is what makes the procedure safe and effective.
Microscopic particles are released into those arteries, gently reducing the prostate's blood supply. Deprived of that flow, the overgrown tissue begins to shrink — without any of it being cut or removed.
The pinhole needs no stitches. Most men go home within hours and return to normal activity within days, with symptoms easing over the weeks that follow as the prostate gradually shrinks.
Straight answers to the questions that come up most often in consultation.
PAE is specifically designed to preserve sexual function. Unlike some surgical options for BPH, it carries little risk of retrograde ejaculation or erectile difficulty — one of the main reasons men choose it.
The procedure is done under light sedation and local anesthesia, not general anesthesia. Most men feel little during it and only mild discomfort afterward, managed easily without strong pain medication.
Many men notice improvement within a few weeks as the prostate shrinks, with continued improvement over a few months. The timeline is gradual rather than immediate — the prostate is shrinking naturally, not being removed.
PAE is often an excellent option precisely when a prostate is very large — cases where some other minimally invasive treatments become less practical. Size alone rarely rules it out; a proper work-up determines fit.
PAE is particularly valuable for men with moderate to very large prostates, men who want to avoid the risks of traditional surgery, and those for whom medication has stopped working.
Whether it's the right choice depends on a proper work-up — imaging, flow testing, and a full picture of your symptoms. That's where care begins.
Book a ConsultationDr. Shusterman's book Shrink the Prostate: Why Prostatic Artery Embolization is the Future of BPH Treatment lays out the full protocol — how PAE works, who it's right for, and what to expect — for patients who want the complete picture before deciding.
Visit the LibrarySchedule a consultation and start with a complete diagnostic picture — and a treatment plan built around the smallest effective step.
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