A - Prostatic artery embolization (PAE)

There is no upper limit on the maximum prostate size for PAE. Prostatic urethral lift, transurethral resection of the prostate, and water vapor thermal therapy are some of the options for prostates <80 mL in size according to guidelines from the American Urological Associate (AUA). Prostate artery embolization as well as simple prostatectomy, holmium laser enucleation of the prostate (HoLEP), and aquablation are options for large and very large prostates. Notably, the AUA guidelines were updated in 2023 and were significant for their inclusion of prostate artery embolization as a treatment option for lower urinary tract symptoms related to BPH.

This patient desired minimally invasive treatment for his symptoms and was referred for PAE.

According to the 2019 Society for Interventional Radiology position statement, the indications for PAE include moderate to severe lower urinary tract symptoms related to BPH, chronic urinary retention related to BPH as a means to achieve catheter independence, and hematuria of prostatic origin as a means to achieve cessation of bleeding.

Which of the following is considered an indication to perform PAE for lower urinary tract symptoms?

A.   IPSS of 18

B.    Prostate volume <30 mL

C.   Maximal urinary flow > 20 mL/s

D.   Post-void residual 50 mL