The results of our retrospective review demonstrate the increasing popularity of PAE among patients. Excluding small samples in 2015 and 2016, PAE volume increased by 121 % from 2017 to 2018 and 31 % from 2018 to 2019. Our findings also demonstrate that while urology is the largest referral source, the share of urology referrals has decreased from 2017 to 2020. An increasing number of patients self-refer for PAE. Between 2017 and 2020, self-referral has grown from 21 % of PAE volume to 39 %.
Further study of patients who self-referred to determine the method through which they learned about PAE, such as word-of-mouth, advertising, media, or other sources, could allow IR practices to reach more patients directly. While our results indicate a growing appetite for PAE among our patient population, to our knowledge there have been no large studies assessing patient understanding of PAE. As the generalizability of the present study is limited by its single-system design, future work examining PAE referral and volume at the regional and national level will be useful in assessing broader patient knowledge of and access to PAE. Patients have a wide range of options for treatment for LUTS secondary to BPH, ranging from conservative medical management, to minimally invasive options including PAE, to more invasive procedures such as transurethral prostate resection, Urolift, Rezum, and prostatectomy. Greater understanding of the patients who self-referred to PAE may help interventional radiologists assess the methods by which they can educate BPH patients about minimally invasive alternatives.
In addition to further study of patient knowledge of PAE, assessment of awareness of PAE among primary care providers could be useful. Internal medicine/primary care provider referrals for PAE grew from 2 to 2017 to 10 in 2019, but comprised a smaller share of total referrals in 2019 (12 %) than urology (51 %) and self-referrals (33 %). Educating internal medicine, geriatrics, and family medicine departments on PAE as a treatment option for BPH could present an opportunity to reach more patients and cultivate another referral source.
As seen with the relatively low penetration of uterine fibroid embolization compared to hysterectomy, patient awareness of IR procedures can be concerningly low despite establishment of safety and efficacy (Makris et al. 2020). Further study of public awareness of PAE is crucial in spreading access to all patients who might benefit from the procedure.