Prostate artery embolization is a safe and effective minimally invasive treatment option for men over 80 with benign prostatic hyperplasia, achieving an 80.8% clinical success rate with significant symptom improvement and no severe complications.
- Technical success achieved in 98.3% of cases (57 of 58 patients) with mean age of 85.2 years
- International Prostate Symptom Score improved from 18.7 to 9.3 at 12 months, with quality-of-life scores improving from 4.5 to 1.8
- Catheter independence achieved in 73.1% of evaluable patients and hematuria resolved in all affected cases
- Only 19.2% experienced complications, with none classified as severe or life-threatening
- Offers a safe alternative to surgical options like transurethral resection of the prostate for elderly, frailer patients
Minimally invasive prostate artery embolization (PAE) is technically feasible, safe, and effective in men over 80 years old, a group in Boston has reported.
Researchers at Massachusetts General Hospital and Brigham and Women's Hospital conducted a retrospective study of 58 men aged 80 or older who underwent PAE between January 2015 and August 2025, with findings supporting its use in nonsurgical candidates or those who prefer a less invasive approach.
“In patients aged ≥80 years, PAE is technically feasible and provides clinically meaningful improvement across presenting indications, including [lower urinary tract symptoms], catheter-dependent urinary retention, and prostatic bleeding,” noted lead author Kausthubh Hegde, MD, and colleagues. The study was published August 14 in the Journal of Vascular and Interventional Radiology.
Benign prostatic hyperplasia (BPH) is highly prevalent in elderly men and can cause significant lower urinary tract symptoms, urinary retention, and hematuria, or blood in the urine. While surgical options such as transurethral resection of the prostate are effective, they carry elevated risks in older and frailer patients, the researchers explained.
Alternatively, PAE has emerged as a catheter-based option that selectively reduces prostate blood flow, shrinking the gland and relieving obstruction, and has shown efficacy in the general BPH population. Yet data specifically addressing PAE outcomes in elderly patients remain limited, the group noted.
To address the gap, the researchers analyzed outcomes in 58 patients (mean age 85.2 years old) who underwent the procedure across two academic medical centers between January 2015 and August 2025. All embolization procedures were performed by fellowship-trained interventional radiologists. Indications included lower urinary tract symptoms in 29 patients (50%), catheter-dependent urinary retention in 27 (46.6%), and hematuria in 15 (25.9%).
Technical success was defined as successful embolization of at least one prostatic artery, and clinical success was assessed at one, three, six, and 12 months using the International Prostate Symptom Score (IPSS), quality-of-life scores, catheter status, and hematuria resolution.
Technical success was achieved in 57 of 58 patients (98.3%). Among 52 patients evaluable for clinical outcomes, IPSS scores fell from 18.7 to 9.3 at 12 months (p < 0.001), and quality-of-life scores improved from 4.5 to 1.8 (p < 0.001). Catheter independence was achieved in 19 of 26 evaluable patients (73.1%), and hematuria resolved in all 12 affected patients. Overall clinical success was 80.8%. Lastly, complications occurred in 10 patients (19.2%), with none classified as severe or life-threatening, the researchers reported.
“These findings support PAE as an important minimally invasive treatment option for elderly patients who are nonsurgical candidates or who prefer a less invasive approach,” the group wrote.
Longer follow-up is needed to confirm similar durability of benefit and to determine the incidence of recurrent symptoms, yet given the advanced age, comorbidity burden, and limited life expectancy of this population, meaningful symptomatic improvement at 12 months remains an important clinical endpoint, the researchers concluded.
The full study is available here.
