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Elected by his peers for inclusion in The Best Doctors in America® 2011-2022.
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2/7/25 NOTE: I am recovering from surgery and will not be seeing patients for a while, I hope to return late April 2025. Until then you can still be treated by one of my many excellent IR partners, but you will need to have your doctor fax an order for your procedure to Methodist Radiology at 210-575-3736.
Hi, I'm John Thomas, MD, and it is a grim fact of life for all men: By age 50, half of us will have Benign Prostatic Hyperplasia (BPH), and if you live long enough, you WILL develop BPH.
Percent of men with BPH
PAE Overview Video
Here is a video about PAE. It may take a couple of minutes to download but it is worth the wait. Steve's experience is so similar to that of my patients. He didn't want surgery or general anesthesia. The BPH medications didn't work for him. But PAE did!
John Thomas, MD FSIR FACR
The prostate gland surrounds the urethra, the tube that drains your urinary bladder and carries semen during ejaculation. Beginning in your 40's the prostate starts to grow. As it gets bigger it begins to pinch off the urethra making it harder to urinate. As this happens you will begin to notice that it takes longer to start your urine stream, and that the stream is not as powerful as it was when you were young. Right after you urinate your bladder still feels partially full. You have to urinate more frequently. And you have to get up multiple times at night to urinate.
For most men these symptoms can be controlled for a long time with medication. But if the medication fails, surgery to remove the enlarged prostate has been the traditional solution.
Traditionally, if medical therapy failed to control your symptoms, surgery was your only option...
Isn't there an alternative to surgery?
Yes there is.
A procedure developed over a decade ago is PAE (Prostate Artery Embolization). In 2018 Great Britain's National Health Service began recommending it as an alternative to surgery for men seeking relief from the symptoms of an enlarged prostate. So what, you say? Well in Great Britain all health costs are paid by the National Health Service; if they had any doubts about PAE's effectiveness they would want men to keep getting TURPS.
What about in the US? In 2019 The Society of Interventional Radiology (my professional society) along with the Cardiovascular and Interventional Radiological Society of Europe, the Société Française de Radiologie and the British Society of Interventional Radiology said in a position statement that "Prostatic artery embolization (PAE) is a safe, effective, and minimally invasive treatment for enlarged prostate and should be presented as a treatment option for appropriately selected patients".
A final holdout on this position was the American Urological Association (AUA). The AUA took the position that PAE was "experimental" and should only be done in a clinical trial because it had not yet been studied enough, even though every other major medical society in the world recognized its effectiveness.
Finally, in 2023, the AUA amended this position to accept PAE as a safe and effective clinical option when done by an interventional radiologist experienced with the procedure, like myself. Hopefully, this will finally cause insurance companies to grant authorization for the procedure, as many of them previously used the AUA position to deny authorization claiming PAE was "experimental".
PAE is a challenging procedure to perform. The IRs of STRG have been performing PAE since 2013 and have gained invaluable experience in that time.
PAE is a minimally invasive procedure that we perform at Methodist Hospital here in San Antonio.
It is an outpatient procedure: have it in the morning and leave that afternoon with a bandaid on the site; no staples, no stitches.
The procedure is painless, though we give you a sedative to help you relax.
Afterwards, most men report a burning sensation in their bladder and an increased urgency to pee that lasts 7-10 days, sometimes longer.
But within weeks your prostate will have shrunk so that you are urinating easier!
A procedure developed over a decade ago is PAE (Prostate Artery Embolization). In 2018 Great Britain's National Health Service began recommending it as an alternative to surgery for men seeking relief from the symptoms of an enlarged prostate. So what, you say? Well in Great Britain all health costs are paid by the National Health Service; if they had any doubts about PAE's effectiveness they would want men to keep getting TURPS.
What about in the US? In 2019 The Society of Interventional Radiology (my professional society) along with the Cardiovascular and Interventional Radiological Society of Europe, the Société Française de Radiologie and the British Society of Interventional Radiology said in a position statement that "Prostatic artery embolization (PAE) is a safe, effective, and minimally invasive treatment for enlarged prostate and should be presented as a treatment option for appropriately selected patients".
A final holdout on this position was the American Urological Association (AUA). The AUA took the position that PAE was "experimental" and should only be done in a clinical trial because it had not yet been studied enough, even though every other major medical society in the world recognized its effectiveness.
Finally, in 2023, the AUA amended this position to accept PAE as a safe and effective clinical option when done by an interventional radiologist experienced with the procedure, like myself. Hopefully, this will finally cause insurance companies to grant authorization for the procedure, as many of them previously used the AUA position to deny authorization claiming PAE was "experimental".
PAE is a challenging procedure to perform. The IRs of STRG have been performing PAE since 2013 and have gained invaluable experience in that time.
PAE is a minimally invasive procedure that we perform at Methodist Hospital here in San Antonio.
It is an outpatient procedure: have it in the morning and leave that afternoon with a bandaid on the site; no staples, no stitches.
The procedure is painless, though we give you a sedative to help you relax.
Afterwards, most men report a burning sensation in their bladder and an increased urgency to pee that lasts 7-10 days, sometimes longer.
But within weeks your prostate will have shrunk so that you are urinating easier!
If you have been told that TURP or Prostatectomy are your only options, you owe it to yourself and your loved ones to look into PAE first.
PAE is effective 80% of the time. If it does not work for you then go on to the more invasive surgeries.
PAE has no risk of causing lifelong problems that a TURP or prostatectomy can cause: no erectile disfunction, no retrograde ejaculation, no incontinence.
PAE has no risk of causing lifelong problems that a TURP or prostatectomy can cause: no erectile disfunction, no retrograde ejaculation, no incontinence.