Podcast Summary

Podcast: Rena Malik, MD Podcast
Episode: Moment: Top 5 Common Side Effects After Prostate Artery Embolization [And How to Manage Them]
Date: January 7, 2026
Host: Dr. Rena Malik
Guest: Dr. Aaron Fishman (Interventional Radiologist)

Episode Overview

This episode features Dr. Rena Malik and guest Dr. Aaron Fishman discussing the top 5 common side effects of Prostate Artery Embolization (PAE), how to manage them, and what patients should realistically expect after undergoing the procedure. The conversation delves into immediate and long-term outcomes, candidacy, technical advances in embolization, and strategies for identifying experienced providers. Listeners gain practical, science-backed advice on PAE, along with personal insights from two leading experts in the field.

Key Discussion Points & Insights

Immediate Side Effects After PAE

• Worsening of Urinary Symptoms

  • Most patients experience a short-term increase in urinary symptoms (frequency, urgency, nocturia) for about a week post-procedure.
  • Dr. Fishman likens recovery to post-workout soreness, not a true "injury."
  • Quote:
    “Most people have about a week of symptoms where they feel worse, and so all of their urinary symptoms get worse for about a week. The prostate gets a little angry after you cut off its blood supply… then they start to feel a lot better after that.” – Dr. Fishman [00:11]

• Bladder Irritation & Pelvic Pressure

  • Common and expected; managed with anticholinergic medications when needed.
  • Symptoms include pelvic pressure and frequent nighttime urination (nocturia).

• Sexual Activity & Return to Normal Life

  • Minimal restrictions: patients can resume most normal activities right away, except for no heavy lifting for 24 hours due to arterial puncture.
  • Quote:
    “They can go to the gym… go out with friends, but they’re going to be peeing a lot.” – Dr. Fishman [01:18]

Readmissions & Complications

• Hospital Readmission is Rare
  • Study cited by Dr. Malik suggested a higher readmission rate for abdominal pain post-PAE, but Dr. Fishman attributes this to lack of patient preparation and reassurance in early procedural days.
  • Most side effects are managed at home via medication and follow-up.
  • Quote:
    “Coming back to the hospital is almost unheard of. We manage all of these symptoms at home with medications.” – Dr. Fishman [02:25]

Long-Term Outcomes & Recurrence

• Reoperation/Recurrent Symptoms
  • Older studies suggest about a 20% recurrence rate at 5–6 years.
  • Ongoing research into improved embolic materials (e.g., "glue") aims to lower recurrence rates.
  • Anatomy (collaterals, artery size) plays a significant role in outcome.
  • Quote:
    “The data is actually very interesting. It’s about 20% recurrent symptoms at around 5, 6 years ... But 20% recurrence is not ideal. We want to do better than that.” – Dr. Fishman [03:43]

Common Side Effects vs. True Complications

• Expected Side Effects:

  • Frequency, urgency, burning (dysuria), worsened nocturia — nearly universal but temporary.
  • Pain with urination (dysuria) can be distressing but is treatable.
  • Blood in semen (hematospermia) is uncommon, but not rare, and is usually benign.
    • May last weeks to a month depending on ejaculation frequency.
    • Quote:
      "The biggest one is really just frequency, urgency, burning and worsened nocturia or peeing at night. That’s… almost everybody gets one of those symptoms." – Dr. Fishman [06:29]

• Management

  • Most symptoms fade in days to two weeks; medications can ease discomfort, though time is the best remedy.

Radiation Exposure & Safety Concerns

• Radiation Risk is Low
  • Modern equipment and skilled operators significantly reduce exposure.
  • Comparable to, and often less than, a CT scan.
  • Patients advised to find experienced operators for both optimal outcomes and minimal radiation.
  • Quote:
    “The machines we use now are so low that the radiation exposure is super low. And like I said, it’s similar to what you would get from a CAT scan. So… it’s really not a lot of radiation.” – Dr. Fishman [08:34]

Ideal Candidates & Procedure Limitations

• Best Candidates
  • Moderate to severe BPH symptoms, prostate size above ~60 grams, good arterial anatomy.
  • Those who want to avoid surgery or medications, or have failed medications.
  • Procedure is effective for a wide range of prostate sizes — even very large glands (>150g).
  • Challenges with Smaller Prostates
    • Arteries are smaller; less dramatic volume reduction.
    • Still possible to benefit if vascular anatomy is favorable.
  • Quote:
    “There really is no size limitation with this…” – Dr. Fishman [09:45]

Technical Factors & Advances

• Finding and Embolizing Collaterals

  • Success partly depends on identifying all arterial feeders/collaterals to the prostate.
  • New imaging (photon counting CT, AI-assisted planning) may improve patient selection and predict outcomes.

• Operator Experience Matters

  • Patients urged to research providers:
    • Ask about their experience, technique, and outcomes.
    • High-volume, focused practitioners tend to achieve better results.
  • Quote:
    “If you can’t get in touch with a practice or an interventional radiologist that does it, even when you’re trying to make an appointment, it may not be the right fit for you. You have to really do your research.” – Dr. Fishman [13:46]

Future Developments

• Research Directions

  • Exploring new embolic materials (e.g., liquid agents) to improve efficiency and reduce recurrence.
  • Applying advanced imaging and artificial intelligence to personalize patient selection.
  • Cross-applications of embolization in other disease areas (fibroids, osteoarthritis, hemorrhoids).

• Increasing Role of Patient Awareness

  • Many candidates and referring providers are still unaware of what PAE offers.
  • Radiology remains a “referral-dependent” field but stands to gain from more direct patient outreach.

Notable Quotes & Memorable Moments

• On Immediate Side Effects:
  “The prostate gets a little angry after you cut off its blood supply…” – Dr. Fishman [00:11]

• On Recovery:
  “You’re going to hate me for two weeks, maybe less, and then you’re going to feel a lot better.” – Dr. Fishman [01:05]

• On Hematospermia:
  “For some people, it can make a whole month and they are still seeing blood in their semen. ... as long as it goes away, nothing to really worry about.” – Dr. Malik [07:38]

• On The Future of PAE:
  “I know that when I need a procedure for this, I’m going to have an embolization.” – Dr. Fishman [11:33]

• On Patient Preparation:
  “If you know what you’re about to get into, it’s much easier. You just don’t want to be surprised, you know, the next day that you’re, you know, you’re peeing every, every 10 minutes.” – Dr. Fishman [02:25]

Timestamps for Key Segments

• Worsening of Symptoms/Expectations: [00:11] – [01:05]
• Return to Activity & Sexual Function: [01:11] – [01:57]
• Hospital Readmissions & Managing Symptoms: [01:57] – [03:01]
• Long-Term Success & Recurrence: [03:12] – [04:36]
• Blood in Semen (Hematospermia): [07:05] – [08:02]
• Radiation Safety: [08:15] – [09:41]
• Ideal Candidates & Limiting Factors: [09:41] – [11:22]
• Finding the Right Provider/Operator Experience: [13:46] – [14:37]
• Technical Innovations and AI in Planning: [17:46] – [18:45]
• Expanding Indications for Embolization: [15:30] – [16:21]

Conclusion

This insightful conversation provided clear, candid, and actionable information on what patients can expect after PAE, focusing on the most common side effects, realistic recovery timelines, and the importance of operator skill and technology in achieving the best outcomes. Drs. Malik and Fishman demystify the procedure, emphasizing patient preparation, shared decision-making, and the evolving landscape of interventional radiology in men’s health.

For more, explore the full episode or stay tuned to Dr. Malik’s podcast for future deep-dives on sexual and pelvic health.