Enlarged prostate (BPH)
Five- and ten-year data on prostate artery embolization, how often men need another treatment, and how PAE compares with TURP over time.
Editorially updated October 12, 2026. This educational article was prepared by SoCal Interventional using the cited primary and authoritative sources. It does not replace an individualized medical evaluation.
Quick answer: For most men who respond to prostate artery embolization (PAE), the improvement lasts for years rather than months. In the largest published long-term series (1,072 men followed for an average of about 4.4 years), symptom scores, quality of life and urinary flow stayed improved, but the proportion who needed a further treatment grew over time, to roughly 21% at 5 years and about 58% at 10 years. In a randomized trial, TURP gave larger and more durable improvement than PAE at 5 years. PAE is therefore best understood as a less invasive option with a real chance of needing a repeat or alternative treatment later, not as a one-time cure.
Prostate artery embolization is offered at our Fountain Valley office in Orange County as well as in Los Angeles and Tarzana.
In PAE studies, a result “lasts” when the symptom score stays meaningfully lower than before treatment and no further treatment has been needed. Durability is therefore reported two ways: the average symptom improvement over time, and the share of men who later needed medication, a repeat embolization or surgery. Both numbers are needed to judge how long PAE lasts.
Studies measure durability in two ways. The first is the symptom score: the International Prostate Symptom Score (IPSS) runs from 0 to 35, and a drop of several points that is still present years later counts as a durable result. The second is re-intervention: the share of men who later need medication again, a repeat embolization or a urologic procedure. A treatment can keep an average score low while a growing minority of patients drop out of that average because they were treated again, so both numbers matter.
In the long-term series, “clinical success” combines a meaningful fall in the symptom score, an acceptable quality-of-life score and no need for further treatment. Men who do not meet all of those criteria are counted as failures even if they feel somewhat better, which makes the long-term success figures conservative.
The long-term data show that most men keep their improvement for several years: in the largest series, re-intervention rose to roughly 21% at 5 years and about 58% at 10 years, while the randomized trial against TURP found that surgery gave a larger and more durable benefit at 5 years. The studies are summarized in the table.
| Study | Design and size | Follow-up | Durability finding |
|---|---|---|---|
| Bilhim et al., Cardiovasc Intervent Radiol 2022 | Single-centre retrospective series, 1,072 men | Mean about 4.4 years, up to 10 years | IPSS, quality of life and peak flow significantly improved; re-intervention roughly 21% at 5 years and about 58% at 10 years |
| Bilhim, CIRSE 2019 presentation (Lisbon registry) | 1,550 men, retrospective analysis of prospective data | 1, 6, 12 months, then yearly to 10 years | Cumulative clinical success 88.1% at 1–12 months, 85.1% at 2–5 years, 76.8% at 6–10 years; IPSS reduction about 13.5–14 points at every interval |
| Müllhaupt, Abt et al., Eur Urol Focus 2024 | Randomized trial, PAE vs TURP, 99 men | 5 years (56 men reached the 5-year visit) | TURP improved IPSS about 3.8 points more than PAE and did better on peak flow and residual urine; PAE judged inferior to TURP for symptom relief at 5 years |
| UK-ROPE registry (presented CIRSE 2017, published BJU Int 2018) | Multicentre registry, 216 PAE and 102 surgical patients | 12 months | Median IPSS improvement 10 points after PAE vs 15 after TURP; 5% of PAE patients needed re-intervention within 12 months (11.6% including planned later operations) |
| Pisco et al., Eur Urol 2020 | Randomized sham-controlled trial, 80 men | 6–12 months | PAE improved symptom score and quality of life significantly more than a sham procedure; adverse events similar (35% vs 32.5%) |
Read together, the series data say that most men keep their improvement for several years, while the randomized data say that TURP gives a larger average benefit and holds it better. Both are true at the same time, and neither tells an individual man how long his own result will last.
The prostate keeps growing with age, and embolization does not change that biology; it reduces the blood supply to the tissue that was enlarged at the time of the procedure. Blood supply may also be partly restored over the years through small collateral arteries. Technical factors matter as well: how completely the prostate arteries are reached and treated influences the result, which is why the UK-ROPE investigators emphasized the experience of the treating interventional radiologist.
Some men who are counted as failures never responded in the first place rather than losing a response. Trials report their primary outcome at 6 or 12 months for this reason: if symptoms have not improved by then, another treatment is usually discussed rather than waiting.
When symptoms return, the options are the same ones a man had before PAE: restarting or adjusting BPH medication, a repeat embolization if the arteries can still be reached, or a urologic procedure such as TURP, HoLEP, Aquablation or a minimally invasive office treatment. A prior PAE does not prevent surgery. Our PAE vs TURP comparison and PAE vs medication article explain how these choices are weighed.
Durability questions come after recovery. Most men notice gradual improvement over the first weeks to months rather than immediately; our PAE recovery timeline describes what is typical day by day and when to call. A follow-up symptom score at 3 to 6 months is the usual point at which the result is judged, and yearly check-ins afterwards are how the long-term studies tracked whether it held.
For some men, yes. In the largest single-centre series (1,072 men followed for a mean of about 4.4 years), symptom relief was durable for most patients, but the share who needed another treatment rose with time, to roughly one in five by 5 years and more than half by 10 years. Durability depends on prostate anatomy, how completely the arteries were treated and how the gland continues to grow.
Repeat embolization is one of the options when symptoms return, alongside medication or a urologic procedure such as TURP. Whether a repeat PAE is sensible depends on imaging of the prostate arteries and on why the first treatment lost effect; this is decided case by case.
In the Swiss randomized trial, TURP produced larger improvements in symptom score, urinary flow and residual urine at 5 years, and PAE was judged inferior on symptom relief. PAE avoids a hospital stay, a urinary catheter in most cases and the sexual side effects of surgery, so the trade-off is individual.
Improvement is usually judged over the first 3 to 6 months, which is why trials report their primary results at 6 or 12 months. A man whose symptoms have not improved by 6 months is unlikely to improve further without another treatment.
In the Lisbon registry data presented at CIRSE 2019, men with prostates over 100 mL had clinical success of 80.7% short-term and 75.3% long-term, similar to the overall group, so a large gland by itself does not predict early failure. Anatomy of the prostate arteries and the completeness of embolization matter more.
Many men reduce or stop alpha-blockers or 5-alpha-reductase inhibitors after a successful PAE, but this is decided with the treating team rather than assumed. If symptoms return years later, restarting medication is one of the first steps before considering a repeat procedure.
Call (310) 929-0026 or request a consultation. Orange County patients are seen at our Fountain Valley office, 10900 Warner Avenue, Suite 101A, Fountain Valley, CA 92708; Los Angeles patients are seen in Van Nuys and Tarzana. Bring any prostate imaging, PSA results and your current medication list.
Medical disclaimer: This article provides general education and cannot predict how long any individual patient’s result will last. Figures above are averages from the cited studies; your own candidacy, likely benefit and alternatives require an in-person evaluation.
Explore more: Read the complete prostate artery embolization treatment guide, who is a candidate for PAE, the PAE Patient Resource Center, and our Medical Editorial Policy.
Medical content reviewed by Nathanael Sabbah, MD, interventional radiologist. Last reviewed: October 2026.