Promising Minimally Invasive Option Emerging in the Treatment of Benign Prostatic Obstruction: Prostatic Artery Embolization

Prostatic artery embolization (PAE) has emerged as a minimally invasive treatment for benign prostatic obstruction (BPO), offering clinically meaningful symptom improvement with a favorable perioperative safety and sexual function profile. This narrative review synthesizes the current evidence on PAE relative to transurethral resection of the prostate (TURP) and holmium laser enucleation (HoLEP), and other minimally invasive surgical treatments (MISTs). PAE generally offers a more favorable perioperative safety profile and shorter recovery time, at the cost of higher reintervention rates. PAE improves lower urinary tract symptoms, quality of life, and urinary flow; however, the magnitude of improvement is generally smaller than that observed in comparative studies with TURP and HoLEP. At the same time, PAE is consistently associated with fewer perioperative complications, shorter recovery time, and a significantly higher preservation of ejaculation function. Reintervention rates after PAE are significantly higher than those after TURP, reaching approximately one in five patients at 2 years and nearly half at 5 years in long-term randomized follow-up, suggesting limited long-term durability compared with resective surgery. This review summarizes current patient selection criteria, anatomic and technical considerations, embolization material choices, and clinical outcomes, and also presents comparative data with TURP, HoLEP, and GreenLight photoselective vaporization. Emerging technologies, including imaging guidance and AI-assisted planning, may further optimize patient selection and procedural consistency, but longer-term comparative trials and standardized protocols are needed. Overall, PAE offers an option for carefully selected patients who prioritize functional preservation or are at high surgical risk, with the added disadvantage of lower long-term durability compared to standard surgical approaches.