A minimally invasive, same-day procedure to treat an enlarged prostate — no surgery, no general anesthesia, and a low risk of sexual side effects. Performed by one of New York's highest-volume PAE specialists — a pioneer of transradial wrist-access PAE and liquid embolic technique at Mount Sinai.
Overview
Prostate artery embolization (PAE) is an FDA-authorized, catheter-based procedure that treats benign prostatic hyperplasia (BPH) — commonly known as an enlarged prostate — by reducing the prostate's blood supply. Without that blood supply, the prostate gradually shrinks over weeks, relieving the urethral pressure that causes urinary symptoms.
The procedure is performed entirely through a small puncture at the wrist — a transradial technique pioneered at Mount Sinai by Dr. Fischman. Using real-time X-ray guidance, a catheter is navigated to the prostatic arteries where tiny microspheres (smaller than a grain of sand) are delivered to block blood flow. There is no surgical incision, no general anesthesia, and no foley catheter required in most cases.
PAE is included in the 2026 American Urological Association (AUA) BPH Guideline, which strengthened the evidence grade for PAE in prostates 50 mL or larger, and it is covered by Medicare and most major insurance plans. BPH is extremely common — about half of men have it by age 60, and up to 90% by their 80s. In randomized trials, PAE has provided symptom relief similar to TURP at one year, as a minimally invasive alternative to surgery.
Patients go home the same day and return to light activities within 1–2 days. Urinary symptoms improve progressively over 4–8 weeks as the prostate shrinks, with maximum benefit achieved by 3–6 months.
In randomized trials, PAE improved urinary symptom scores about as much as TURP through 12 months. Most men notice improvement within 4–8 weeks.
Patients go home the same day as the procedure — no overnight hospital stay required.
Dr. Fischman's liquid embolic technique has reduced procedure time compared to conventional PAE methods.
Access via a single small puncture at the wrist. No groin incision. No stitches.
Expertise
Dr. Fischman was among the first in the United States to perform PAE via the transradial (wrist) approach — a technique that eliminates the need for groin access, allows patients to walk immediately after the procedure, and enables same-day discharge. He has trained dozens of physicians worldwide in this method.
Dr. Fischman served as principal investigator on the BEST Trial — one of the most significant clinical trials in PAE history, directly comparing PAE to TURP (transurethral resection of the prostate), the longstanding surgical gold standard for BPH. The trial was designed to compare symptom relief, safety, and recovery between the two procedures head to head.
Dr. Fischman helped develop the use of liquid embolics (n-BCA glue) for PAE — an advanced technique that significantly reduces procedure time, lowers radiation exposure for both patient and physician, and may improve the durability of results. This approach is available at few centers in the United States.
See the published glue results ↓
Mount Sinai was involved in the clinical trials that led to FDA authorization of PAE and continues to serve as a national center of excellence for PAE research and training. Dr. Fischman serves as Program Director of Mount Sinai's nationally recognized Interventional Radiology residency program.
Dr. Fischman has authored over 130 peer-reviewed publications and textbook chapters on interventional radiology, with numerous studies focused specifically on PAE outcomes, technique refinement, and complication avoidance. He is a recognized authority cited by researchers worldwide.
Dr. Fischman has performed thousands of PAE procedures at Mount Sinai, making his program one of the highest-volume in New York and among the most active in the United States. Volume matters in PAE — experienced operators achieve better outcomes, shorter procedure times, and lower complication rates. Patients travel from across the country and internationally for access to this level of expertise.
Dr. Fischman has been recognized as a Castle Connolly Top Doctor for eight consecutive years — a distinction awarded by a physician-led organization based on peer nominations and rigorous review. He holds board certification in both Diagnostic Radiology and Vascular & Interventional Radiology.
The Procedure
Dr. Fischman reviews your symptom history, prior imaging (MRI or CT), and lab results to confirm candidacy for PAE and plan the procedure. Telemedicine consultations are available for out-of-state and international patients.
Under mild sedation and local anesthesia, a catheter is introduced through a small puncture at the wrist. Using real-time fluoroscopic imaging, Dr. Fischman navigates the catheter through the arterial system to the prostatic arteries with precision.
Liquid embolics (n-BCA glue) are Dr. Fischman's primary embolic agent — a technically advanced approach that shortens procedure time, lowers radiation exposure, and offers more precise, controlled delivery than conventional methods. Microspheres are used in select cases where anatomy dictates. This distinction is central to why patients travel nationally and internationally to Dr. Fischman: for access to a technique most centers do not offer.
You recover briefly on-site, then go home with a small bandage at the wrist — no overnight stay, no surgical wound. Most patients return to desk work within 2–3 days and resume full activity within one week.
Recovery Timeline
PAE vs. Surgery
TURP (transurethral resection of the prostate) has long been the surgical standard of care for BPH. While effective, it carries significant risks — including retrograde ejaculation in the majority of patients and requirements for general or spinal anesthesia and multi-day hospitalization. PAE offers comparable symptom relief with a substantially better safety profile.
| PAE Dr. Fischman · Mount Sinai |
TURP Traditional Surgery |
|
|---|---|---|
| Surgical Incision | ✓ None — wrist access only | Urethral surgical approach |
| Anesthesia | ✓ Mild sedation only | General or spinal anesthesia |
| Hospital Stay | ✓ Same-day discharge | 1–2 day inpatient stay |
| Recovery Time | ✓ 3–5 days to light activity | 2–4 weeks |
| Foley Catheter | ✓ Not required in most cases | Required post-operatively |
| Sexual Side Effects | ✓ Preserved in most patients | Retrograde ejaculation in ~65–70% |
| Symptom Improvement | Similar to TURP at 12 months in randomized trials | High — with greater procedural risk |
| Insurance Coverage | ✓ Medicare + most plans | Covered |
Individual outcomes vary. This comparison is for informational purposes only. Dr. Fischman will discuss your specific case and the most appropriate treatment options during your consultation.
The Evidence
Most published PAE data come from particle embolics (microspheres). A growing body of research — from Mount Sinai and centers in Europe and the Middle East — now reports results with n-BCA liquid embolic (glue), the technique Dr. Fischman has used for the past five years. Glue permanently seals the small prostatic arteries, which is designed to reduce the recanalization that can cause symptoms to return after particle PAE.
| Study | Patients | Key findings |
|---|---|---|
| Pooled evidence | ||
| Meta-analysis of liquid embolics for PAE[1] | 11 studies · 913 men (8 of 11 studies used glue) | Average symptom score (IPSS) fell 10.7 points, quality-of-life score improved 2.7 points, and prostate volume shrank 31 mL. No severe adverse events. |
| Systematic review of glue PAE[2] | 6 studies · 667 men | Symptom improvement in 83–94% of patients across studies, shorter procedure times, erectile function mostly preserved, no major adverse events. |
| Durability | ||
| Three-year results in older men[3] | 101 men · median age 79 | 92.5% clinical success at 3 years (IPSS 25.3 → 15.3); 73.5% of men with a urinary catheter were able to void on their own. |
| One-year results[4] | 186 men | IPSS 20.1 → 10.0 and quality of life 5.1 → 2.2 at 12 months; prostate volume down about one-third; erectile function unchanged; no major complications. |
| Six-month results[5] | 103 men | IPSS 20.2 → 8.9 at 6 months with 100% technical success. |
| Glue vs. particles | ||
| Head-to-head comparison[6] | 62 men | Similar symptom improvement and safety to microspheres, with shorter procedures (81 vs 112 min), less fluoroscopy time, and roughly half the radiation dose. |
| Glue vs. PVA particles[7] | 110 men | Similar, substantial improvements in symptoms, quality of life, flow rate, and prostate volume at 6 months. |
| Repeat PAE after particle embolization[11] | 30 men | When symptoms returned after particle PAE, 83% had reopened (recanalized) prostatic arteries — the problem a permanent liquid embolic is designed to prevent. |
| Dr. Fischman's research | ||
| Mount Sinai glue PAE series[8] | 244 men | 95% technical success; IPSS 20.5 → 9.5 and quality of life 4.0 → 1.8 within about 7 weeks; prostate volume down 28% at 6 months. |
| Glue penetration score[9] | 49 men | 92.5% clinical success when glue penetration was highest; better penetration predicted better outcomes; no significant adverse events. |
| Radiation and fluoroscopy[10] | Comparative study | Compared fluoroscopy time and radiation dose for glue versus microspheres. |
Most glue studies are retrospective single-center series; larger prospective trials are under way. Individual results vary.
Patient Selection
PAE may be appropriate for you if you meet one or more of the following criteria. Dr. Fischman evaluates each patient individually at Mount Sinai, reviewing imaging and clinical history before recommending any procedure.
The first step is a conversation. Dr. Fischman's team will review your history, symptoms, and any prior imaging to determine whether PAE is right for you. Telemedicine consultations are available for patients outside New York and international patients.
Office: Mount Sinai Health System
5 East 98th Street, 12th Floor
New York, NY 10029
Phone: (212) 241-4046
Request a ConsultationInsurance
PAE for BPH is covered by Medicare and many major insurance plans including Aetna, Cigna, United Healthcare, Empire BCBS, and others. Our team will assist with insurance verification and prior authorization prior to your procedure.
Watch the Procedure
Watch Dr. Fischman perform a live PAE via transradial (wrist) access — walking through catheter navigation, anatomy, prostatic artery identification, and microsphere delivery step by step. This case demonstrates the technique in a patient with longstanding symptomatic BPH.
View All PAE Videos →Frequently Asked Questions
TURP (transurethral resection of the prostate) is a surgical procedure that physically removes prostate tissue through the urethra under general or spinal anesthesia, requiring 1–2 days of hospitalization and 2–4 weeks of recovery. It carries a high rate of retrograde ejaculation (65–70%). PAE achieves comparable symptom relief by reducing the prostate's blood supply — through a wrist puncture under mild sedation, same-day discharge, and with preservation of sexual function in the vast majority of patients.
Dr. Fischman has performed thousands of PAE procedures — one of the largest career case volumes of any PAE specialist in New York and among the highest in the United States. He served as principal investigator on the BEST Trial, a multicenter clinical trial comparing PAE to TURP, and has trained physicians from around the world in advanced PAE technique. Mount Sinai remains one of the highest-volume PAE centers in the country.
Yes. The embolic particles used for PAE have been FDA-authorized for treating BPH since 2017. PAE is included in the American Urological Association (AUA) guideline on BPH, and the updated 2026 guideline strengthened the evidence grade for PAE in men with prostates 50 mL or larger. The AUA also advises that PAE be performed by physicians trained in interventional radiology. Mount Sinai participated in the clinical trials that led to FDA authorization.
PAE has a favorable sexual side-effect profile. Retrograde ejaculation, which affects most men after TURP, is uncommon after PAE, and a 2026 meta-analysis found no significant change in erectile or ejaculatory function after PAE. Some men notice a temporary decrease in ejaculate volume or blood in the semen, which usually resolves on its own. For men who want to preserve sexual function, this is one of the main advantages of PAE over traditional surgery.
Most men maintain meaningful improvement in urinary symptoms and quality of life for years after PAE. The long-term studies published to date used particle embolics (microspheres). For the past five years, Dr. Fischman has performed PAE with n-BCA liquid embolic (glue), which permanently seals the small prostatic arteries rather than plugging them with particles, and in his experience recurrence has been lower than historically reported with particles. In his published series of 244 men treated with glue, average symptom scores (IPSS) fell from 20.5 to 9.5 within about seven weeks, and a follow-up study found 92.5% clinical success when glue penetration into the prostate was highest. Longer-term glue data are being collected, and glue is not yet specifically addressed in the AUA guideline. If symptoms do return, usually from prostate regrowth or new blood supply to the prostate, a repeat PAE can be performed — Dr. Fischman has treated patients returning as long as nine years after their original procedure.
Yes. Dr. Fischman sees patients from across the United States and internationally. Telemedicine consultations are available for initial evaluation, imaging review, and treatment planning. Patients typically travel to New York City for the day-of procedure and can return home the same day or the following day. Our team coordinates with referring physicians and can assist with travel logistics for out-of-state patients.
PAE for BPH is covered by Medicare and many major commercial insurance plans. Coverage varies by plan and individual circumstance. Dr. Fischman's team at Mount Sinai will assist with insurance verification, prior authorization, and coverage review prior to your procedure. Contact the office at (212) 241-4046 to discuss your specific insurance plan.
Yes. When lower urinary tract symptoms return years after an initial PAE — usually because the prostate has regrown or the treated arteries have revascularized — a repeat PAE is a safe and effective non-surgical re-intervention. Because the procedure is catheter-based, nothing about the first PAE prevents a second one, and no urethral instrumentation or surgery is required. Dr. Fischman performs repeat PAE at Mount Sinai, including for patients returning as long as nine years after their original procedure, using n-BCA liquid embolic for precise, durable occlusion of the recurrent blood supply.
UroLift uses small permanent implants placed cystoscopically through the urethra to mechanically retract and hold back obstructing prostate tissue. It is best suited for smaller prostates without a prominent middle lobe. It does not shrink the prostate — it simply holds tissue out of the way. Results may diminish over time as the prostate continues to grow.
Rezūm delivers water vapor (steam) through the urethra to thermally destroy prostate tissue. It requires urethral instrumentation under anesthesia and a temporary foley catheter for 1–2 weeks post-procedure. It is effective for mild to moderate enlargement but less so for very large prostates.
Aquablation uses a robotic waterjet system guided by ultrasound imaging to physically remove prostate tissue through the urethra — essentially a high-tech TURP. It requires general or spinal anesthesia, an overnight hospital stay, and carries a risk of retrograde ejaculation, though lower than traditional TURP. It is effective for larger prostates but is still a surgical resection.
Optilume is a drug-coated balloon dilation of the urethra — a newer approach that stretches the urethral channel and delivers a drug (paclitaxel) to reduce restenosis. It is minimally invasive but addresses the urethral narrowing symptomatically rather than shrinking the prostate itself. Long-term durability data is still emerging.
PAE is the only one of these options that does not require urethral instrumentation of any kind. Performed entirely through a wrist puncture using liquid embolics, PAE shrinks the prostate from within by reducing its blood supply — making it uniquely appropriate for patients who want to avoid any urethral or surgical approach, preserve sexual function, and benefit from a technique with over a decade of published outcome data. It is also particularly effective for larger prostates where UroLift, Rezūm, and Optilume may not be suitable. Dr. Fischman will help determine which option is most appropriate for your specific anatomy and goals.
Schedule a consultation with Dr. Fischman at Mount Sinai, New York City — in person or via telemedicine.