AUA Guidelines for PAE: Hope for Silent Sufferers? | Varian

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AUA Guidelines for PAE: Hope for Silent Sufferers?

AUA Guidelines for PAE: Hope for Silent Sufferers?

About 50% of men between the ages of 51 and 60, and some 90% of men over the age of 80 suffer from benign prostatic hyperplasia (BPH), an enlarged, non-cancerous prostate gland that can cause extreme urinary symptoms. Standard-of-care treatments include life-long medications and minimally invasive surgical therapies (MIST) performed through the penis, depending on factors such as patient health condition and severity of symptoms. Recently, however, the American Urological Association (AUA) guidelines2 were updated to include prostate artery embolization (PAE) in its recommended treatments for BPH1, stating that the procedure should be performed by a well-trained interventional radiologist, and opening the doors to more referrals and improved medical insurance coverage.

Dr. Charles Nutting is an interventional radiologist practicing with Endovascular Consultants in Lone Tree, Colorado. He’s been an interventional radiologist for 25 years, and now specializes in liver, knee, and prostate embolization. He’s seeing an upswing in the number of patients asking about PAE and believes the latest AUA guidelines are likely to result in more PAE procedures as patients, urologists, and general practitioners realize its benefits as an alternative minimally invasive treatment for suitable patients.

Dr. Nutting recently spoke as part of a BackTable podcast about PAE in the outpatient-based lab (OBL), hosted by IR Dr. Michael Barraza, of Radiology Associates in Baton Rouge, Louisiana. In addition to offering tips and details on his preferred techniques, Dr. Nutting also spoke about the PAE patient journey and the benefits he’s seen in those he’s treated.

“Some of my angriest patients are self-referrals who weren't told about prostate embolization as an option from their urologists,” Dr. Nutting said. “I believe there's a whole group of men called the ‘silent sufferers,’ who suffer from BPH and won’t go to the urologist because they fear the more invasive nature of the urology treatments. I think bringing the PAE procedure to the forefront will allow these men to come out of the woodwork and be treated.”

Benign prostatic hyperplasia

“The efficiencies of the OBL allows me to treat several PAE patients in the same day,” Dr. Nutting explains. “We have dedicated, experienced staff and standardized equipment. The patients don’t have to deal with the complexities of the hospital campus. They can park right outside of the clinic, the same nurse will get the patient ready for the procedure, perform their sedation and recover them as well. We invested in a state-of-the-art fixed unit angiography suite that allows me to treat all PAE patients in my OBL regardless of BMI.”

As part of his technique, Dr. Nutting accesses the prostatic artery through the femoral artery using a microcatheter and 3D model. He starts by using Embozene 250-micron microspheres from Varian, diluted to the manufacturer specifications, switching to 400-micron Embozene microspheres as he gets closer to the periphery of the gland.

“Patients are discharged an hour after the procedure,” Dr. Nutting says.

Currently, he performs up to 200 PAEs a year, and says that his results are in line with national studies; some 90% of his patients are very happy with the results of the procedure at follow up one to three months later. If possible, Dr. Nutting advises interventional radiologists considering performing PAE in the OBL setting to first gain experience in a hospital environment. This will help with efficiencies and in figuring out a preferred workflow, what catheters work best, and so on.

“Because of the updated AUA guidelines, I believe that the silent sufferers at home are going to start hearing about this new procedure and it’s going to increase prostate artery embolizations,” he says. “It’s an outpatient procedure with a very low-risk profile and it can help 90% of men.”

For more details about Dr. Nutting’s OBL environment, tips and wisdom about procedure techniques, patient selection, follow-up care, and more, listen to the in-depth podcast, ‘PAE in the OBL.’

The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above-referenced institution. Individuals were not compensated for their participation. Prostate artery embolization may not be appropriate for all benign prostatic hyperplasia cases. Individual results may vary. For more information, please visit the Safety Information page.



  1. National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Prostate Enlargement (Benign Prostatic Hyperplasia). Health Information. Accessed 6 Mar. 2024.
  2. American Urological Association. (Published 2021; Amended 2023). Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. Accessed 6 Mar. 2024.