Radiation Safety in Prostatic Artery Embolization: A Review of Current Evidence and Best Practices

Prostatic artery embolization (PAE) is increasingly used as a primary minimally invasive treatment modality for lower urinary tract symptoms associated with benign prostatic hyperplasia. As a complex, fluoroscopic-guided endovascular procedure, PAE necessitates a significant use of ionizing radiation, raising important safety considerations for both patients and medical personnel. The objective of this review is to first summarize the procedural and anatomic fundamentals of PAE, and then to provide a comprehensive overview of the current literature on radiation dosimetry, establish contemporary benchmarks for dose metrics, and present an evidence-based guide to practical dose optimization strategies. Through a thorough review of published clinical studies, this article synthesizes reported values for key radiation indices, including Dose Area Product (DAP), Cumulative Air Kerma (CAK), and Fluoroscopy Time (FT). Furthermore, we will critically examine factors influencing dose variability—including patient complexity, procedural technique, and imaging technology—and will provide a practical, clinically oriented guide to implementing dose-saving measures. Ultimately, this review concludes that while PAE involves a non-trivial radiation burden, a thorough understanding and application of optimization principles can ensure the procedure is performed safely, reinforcing its role as a valuable therapy for BPH.