Once conservative measures stop providing relief from BPH symptoms, men typically face a choice between medication, traditional surgery, and a newer, minimally invasive option: prostate artery embolization (PAE). Here’s how the leading treatments compare.
Medication
Medication is usually the first line of treatment for mild to moderate BPH symptoms. Alpha-blockers, such as tamsulosin (Flomax), relax the muscles of the prostate and bladder neck to improve urine flow. 5-alpha reductase inhibitors, such as finasteride, work more slowly to shrink the prostate over time by blocking the hormone responsible for its growth. Medications can be effective, but they typically need to be taken indefinitely — symptoms often return if the medication is stopped — and some men experience side effects like dizziness or sexual dysfunction.
TURP (Transurethral Resection of the Prostate)
TURP is the traditional surgical approach to BPH and has long been considered the gold standard. A surgeon inserts an instrument through the urethra and removes excess prostate tissue that’s blocking urine flow. TURP is effective and has a long track record, but it requires anesthesia, often a hospital stay, and carries real risks of long-term side effects, including urinary incontinence and sexual dysfunction, along with a recovery period measured in weeks.
Prostate Artery Embolization (PAE)
PAE offers a fundamentally different, non-surgical approach. Rather than removing prostate tissue, an interventional radiologist threads a tiny catheter into the arteries supplying blood to the prostate and injects microscopic particles that reduce blood flow to the gland. Over time, with reduced blood supply, the prostate shrinks and urinary symptoms improve.
Because PAE doesn’t require any surgical access through the penis, it avoids the direct trauma to the urethra and prostate that comes with TURP. The procedure is performed on an outpatient basis using moderate sedation rather than general anesthesia, typically takes one to two hours, and most patients are discharged within an hour of finishing. PAE was added to the American Urologic Association’s guidelines as an acceptable treatment strategy for symptomatic BPH, and it’s covered by most insurance plans.
Comparing the Options
- Invasiveness: Medication is non-invasive but ongoing; TURP is surgical; PAE is minimally invasive with no incision through the penis.
- Anesthesia: TURP typically requires general anesthesia; PAE uses moderate sedation.
- Recovery time: TURP recovery can take several weeks; PAE patients often resume normal activity within days.
- Sexual and urinary function: PAE has been shown to have a lower risk of the incontinence and sexual dysfunction sometimes associated with TURP.
- Hospitalization: TURP often involves a hospital stay; PAE is performed entirely on an outpatient basis.
Which Treatment Is Right for You?
The right choice depends on the severity of your symptoms, prostate size, overall health, and personal preferences — including how you weigh the tradeoffs between an ongoing medication regimen, a well-established surgical option, and a minimally invasive alternative like PAE. A consultation with an interventional radiologist can help you understand whether PAE is a good fit for your specific situation.
New to BPH? Start with our companion post, Enlarged Prostate (BPH) Explained. If you’re in the Kansas City area, learn more on our Enlarged Prostate (PAE) page, or take our PAE quiz to see if this treatment may be right for you.