Prostate Artery Embolization, Prostate Diagnostics, and Biopsy: An Expert Interview with Univ.-Prof. Dr. Dr. Vogl

University Professor Dr. Dr. med. Thomas J. Vogl is an internationally recognized specialist in radiology and is one of the leading experts in the field of diagnostic and interventional radiology. As Director of the Institute for Diagnostic and Interventional Radiology at Frankfurt University Hospital and Professor of Radiology at Johann Wolfgang Goethe University, he has made significant contributions to the advancement of his field.

Prof. Dr. Dr. Vogl is particularly well known for his pioneering work in interventional oncology and vascular radiology, including innovative procedures such as transarterial chemoperfusion (TACP), embolization (TACE), and thermal ablation of tumors using radiofrequency and microwave ablation. Prof. Dr. Dr. Vogl is a highly sought-after scientist and author of numerous scientific articles and standard reference works that set global standards in radiology and radiation therapy. He has received numerous scientific awards and is a member of leading international professional societies. In addition, he contributes to the advancement of his field as an advisory board member for scientific publications.

With his tireless drive for innovation and his unwavering focus on improving patient care, Prof. Dr. Dr. Vogl has earned an outstanding reputation as a physician and scientist. His exceptional expertise and his commitment to medical progress offer new hope and prospects to patients worldwide. His exceptional expertise and dedication make Prof. Dr. Dr. Vogl one of the most respected physicians of his time.

The editorial team of the Leading Medicine Guide had the opportunity to speak with him about prostate artery embolization, prostate diagnostics, and biopsy.

Prostate artery embolization (PAE) is an innovative treatment for an enlarged prostate that is particularly compelling due to a surprisingly simple concept: the targeted reduction of blood supply. This causes the prostate tissue to shrink naturally, which can significantly alleviate typical symptoms such as frequent urination and difficulty urinating—all without major surgery! But how exactly does this minimally invasive procedure work? And what makes it so appealing to many patients? Modern prostate diagnostics, which provide deeper insights into the prostate through the use of various imaging techniques, can already reveal a great deal about the prostate’s condition. If a malignant change is suspected, a prostate biopsy can provide more precise answers by analyzing small tissue samples in the laboratory. 

Prostate artery embolization (PAE) is a minimally invasive procedure that often helps men with benign prostate enlargement (benign prostatic hyperplasia, BPH) when conventional treatments such as medication are not sufficiently effective. 

“Men who have prostate problems usually suffer from hypertrophy—the enlargement of the prostate due to cell growth. This manifests as having to get up more frequently at night due to the urge to urinate, but also as a sudden urge to empty the bladder during the day. This is a massive impairment of quality of life. I recently had a patient who had to get up six times a night. Many patients spend the entire day looking for the nearest place to empty their bladder. As things stand today, patients have three options. Following a urological examination, medication may be prescribed, typically tamsulosin, an alpha-1 receptor blocker that relaxes the muscles in the prostate and can thereby alleviate symptoms. However, this can lead to increased side effects such as dizziness, so this treatment is only suitable to a limited extent. The second option is for the urologist to perform a prostate resection, which alleviates the symptoms. The downside is that problems with incontinence and impotence can occur, which is why this method is not very popular among patients. This is because removing the prostate alters the vas deferens, so that a man’s ejaculate no longer exits forward but instead enters the bladder. “Prostate artery embolization has since emerged as a third option,” explains Prof. Dr. Vogl at the beginning of our conversation, and goes on to elaborate on this new procedure:

“This procedure was developed based on the experience urologists gained during prostate surgery. When a patient began bleeding during surgery, the artery was occluded using small beads—typically made of gelatin or other biocompatible materials—to stop the bleeding. And it was noticed that the prostate shrinks relatively quickly and patients experience fewer problems. It was precisely this phenomenon that was then further developed into a distinct therapy capable of actively and significantly reducing the size of the prostate. This therapy is performed under MRI guidance following a urological examination. If the MRI raises suspicion of a tumor, an additional biopsy is performed, which is also MRI-guided—a feature unique to our center here in Frankfurt am Main. This technique allows for targeted and more precise sampling from suspicious areas of the prostate, which is particularly beneficial for high-risk patients, as it avoids unnecessary biopsies and minimizes false-negative results. As for the associated radiation exposure, it is roughly equivalent to a round-trip flight to Thailand. The way we perform this procedure here in Frankfurt is unique. The patient arrives in the morning on an empty stomach; the procedure, which takes about an hour, is performed on an outpatient basis; the patient rests at our facility for about 4–5 hours and then goes home.”

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A prostate biopsy is recommended in combination with multiparametric magnetic resonance imaging (mpMRI) primarily when prostate cancer is suspected due to an elevated PSA level or abnormal digital rectal exam findings, but a more targeted diagnosis is desired.

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The PAE procedure is relatively minimally invasive. It begins with a small incision, usually in the groin. A thin catheter is then used to deliver tiny particles into the arteries that supply the prostate. These tiny particles selectively block the blood vessels that supply blood to the excess prostate tissue, causing it to shrink and the gland to lose volume overall. Urinary flow improves, and the unpleasant symptoms are alleviated. PAE is particularly well-suited for men who either do not wish to undergo surgical treatment or for whom a more extensive procedure would be too risky due to other health factors. It offers a promising alternative for relieving symptoms without significantly affecting the surrounding tissue.

According to studies, the success rate of prostate artery embolization (PAE) ranges from approximately 75% to 90%—depending on the patient’s specific circumstances and indication—in terms of symptom relief for benign prostatic hyperplasia (BPH). 

PAE can effectively reduce symptoms such as frequent urination, nocturia, and incomplete bladder emptying, leading to a noticeable improvement in quality of life. Since the procedure is minimally invasive and does not require general anesthesia, it represents a gentler alternative to surgical procedures such as transurethral resection of the prostate (TURP) for many patients. Repeat PAE may be necessary in certain cases, particularly if the initial treatment did not achieve the desired effect or if symptoms recur after an initial improvement. “Similar to what happens after prostate resection, the prostate may begin to grow again approximately 5–7 years after embolization. It is therefore important for patients to follow the dietary guidelines recommended for them to keep prostate growth in check. Incidentally, this can also be done as a preventive measure. Patients should also see a urologist regularly, and if the PSA level (prostate-specific antigen) rises, an MRI should be performed,” recommends Prof. Dr. Dr. Vogl.

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A prostate-friendly diet focuses on a balanced, nutrient-rich diet. Foods rich in lycopene, such as tomatoes, are recommended as they can lower the risk of prostate cancer. Saturated fats from red meat should be reduced and replaced with healthy fats from fish and nuts. Whole-grain products and high-fiber foods support digestion, while fruits and vegetables provide important antioxidants. Soy products and green tea may also have a protective effect on the prostate. Dairy products should be consumed in moderation, as high consumption has been linked to an increased risk of prostate cancer. Sugar and processed meats should be avoided to reduce inflammation and promote prostate health.

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“There are currently three major centers in Germany—in Hamburg, Jena, and here in Frankfurt—that have experience with prostate artery embolization. It’s important that the doctor performing the procedure has a lot of experience, since we’re dealing with very small vessels, and the microspheres must be placed in the right spot. Personally, I have already performed over 1,000 procedures. I also think that this method will become more widely available in the future, though probably only if health insurance companies are more cooperative. This would be desirable, since the procedure carries much less risk than surgery and does not require a hospital stay. Of course, surgery does offer one advantage for the patient—it provides immediate relief. After embolization, the first noticeable improvements occur after about 3–4 weeks, and the full effect is achieved after about three months. The patient must also do more on their own, such as pelvic floor exercises,” says Prof. Dr. Dr. Vogl.

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PSA Level (Prostate-Specific Antigen)

The PSA level refers to a protein produced by the prostate and measured in the blood. It is primarily used to screen for prostate cancer and to monitor prostate conditions. An elevated PSA level may indicate prostate cancer, benign prostatic hyperplasia (BPH), or prostatitis (inflammation). A PSA level below 4 ng/ml is often considered normal, although the value varies depending on age and individual factors. Further testing is required if the PSA level is elevated.

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The choice of treatment method increasingly depends not only on medical factors such as the size and location of the prostate, but also on the patient’s individual needs and expectations regarding daily life and the anticipated quality of life after the procedure. 

Compared to surgical procedures such as transurethral resection of the prostate (TURP) and open prostatectomy, PAE offers a minimally invasive alternative that generally results in shorter recovery times and a lower risk of serious complications. This is particularly appealing to patients who fear potential side effects such as urinary incontinence or erectile dysfunction—which can occur more frequently with surgical procedures—and who also wish to return to their normal daily lives as quickly as possible.

“Prostate artery embolization can be performed on patients of all ages. My oldest patient was 94 years old! In younger patients, we must also check whether there might be another underlying issue. In any case, close collaboration with colleagues in urology is essential, which I greatly appreciate here in Frankfurt. In the hands of experienced physicians, the method works very well, and out of 1,000 patients we’ve treated with it, 900 are 100% satisfied,” explains Prof. Dr. Dr. Vogl, and with that, we conclude our conversation.

Thank you very much, Professor Dr. Dr. Vogl—that was a fascinating insight into the options for prostate treatment!