Embolization or surgery?
When tablets aren’t enough: embolization or surgery, side by side.
OVERVIEW
When tablets stop controlling an enlarged prostate, the usual next step is surgery, most often a TURP. There is also a non-surgical option: prostatic artery embolization (PAE). Dr Marios Agathangelou performs PAE in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. PAE shrinks the gland by cutting off its blood supply through a 1–2 mm incision and spares sexual function better than surgery; a TURP trims the blocking tissue from the inside and has the longer track record. Which one suits you depends on the size of the prostate, your symptoms, and your general health.
Below I set the options side by side, in plain terms, so you can see where each one fits before you decide.
THE THREE OPTIONS
MEDICATION
TURP (SURGERY)
EMBOLIZATION (PAE)
SIDE BY SIDE
| EMBOLIZATION (PAE) | SURGERY (TURP) | |
|---|---|---|
| What is done | The arteries are blocked; the gland shrinks | The blocking tissue is trimmed from inside |
| Anaesthetic | Local + sedation | General or spinal |
| Hospital stay | Day case, no catheter | 1–2 nights + a catheter for days |
| Sexual function | Usually preserved | Retrograde ejaculation is common |
| Back to routine | A few days | Several weeks |
| Very large prostate / unfit for surgery | Often still an option | May need a bigger operation, or ruled out |
| GESY | Covered: €0 for the procedure | Covered |
WHO EACH SUITS
Embolization tends to suit you if keeping your sexual function matters to you, if your prostate is very large, if a general anaesthetic is a risk because of your heart or blood-thinning medication, or if you would rather avoid an operation and a catheter.
Surgery tends to suit you if you want the most complete and durable relief and the longest track record, or if the shape of your prostate and symptoms point the urologist toward a TURP.
This is a decision to make with a urologist, not around one. I am glad to speak with yours directly.
GESY COVER
GESY covers both. For embolization, the treatment is part of the inpatient admission, so you pay nothing for the procedure itself. Cost is not the reason to pick one over the other here.
The first outpatient visit, where we decide what suits you, may carry a small GESY co-payment like any specialist visit. You need a valid referral from your personal doctor or a specialist.
COMMON QUESTIONS
Dr Marios Agathangelou, an interventional radiologist, sees patients in Nicosia and Limassol and performs prostatic artery embolization. It is covered by GESY — €0 for GESY beneficiaries.
A TURP gives the most complete and durable relief and has the longer record. Embolization spares sexual function better, avoids a catheter, and reaches men an operation would turn away. The right answer depends on your prostate and what matters to you, not on averages.
This is the difference most men care about. Embolization usually leaves ejaculation and erections as they were. After a TURP, retrograde ejaculation (semen going back to the bladder) is common. For many men that single point settles the choice.
Often yes. Embolization stays open to men an operation would rule out: a very large gland, heart disease, or blood-thinning medication that makes surgery a gamble. We check your case first, but this is one of its real strengths.
Some men who choose embolization need a further treatment down the line, a higher chance than after a TURP, which is more definitive. That trade-off is part of the decision and I will not skip it.
Yes. Both are covered, and for embolization you pay €0 for the procedure. So the choice is about what fits your body and your priorities, not about cost.
SOURCES
Comparisons on this page follow the CIRSE Standards of Practice for prostatic artery embolization and the guidance of the Society of Interventional Radiology and the European Association of Urology. They describe the options in general; they are not advice about your case.
Bring your PSA and ultrasound. We decide together.
In a consultation I look at your prostate, your symptoms and what matters to you — and tell you plainly which path fits.
Most men are home the same evening and back to normal within days; any blood in the urine settles on its own.