Lower urinary tract symptoms due to benign prostatic obstruction (LUTS/BPO) is one of the most common diseases in men, with incidence of 50–60% in the 6th decade of life and 90% among men aged >80 yr [1], and represents a significant economic burden [2]. The drawbacks of established surgical therapies such as transurethral resection of the prostate (TURP) [3], [4], [5] led to a continuous search for minimally invasive treatments (MITs).

Prostatic artery embolisation (PAE) has been increasingly used worldwide in recent years and is now recommended in international evidence-based guidelines [6]. PAE offers some obvious advantages, including performance under local anaesthesia, continuation of anticoagulant drugs, and a fast return to normal activities.

While a short- to midterm subjective improvement in LUTS/BPO following PAE is widely accepted [6], [7], a lack of reliable long-term follow-up data has been the main drawback of PAE so far.

We previously reported 3-mo and 24-mo data from a randomised controlled trial comparing PAE versus TURP in patients with refractory LUTS/BPO [8], [9]. A significant improvement in LUTS/BPO after PAE was observed at both time points, and the procedure was associated with fewer adverse events in comparison to TURP. However, inferior relief of bladder outlet obstruction and the fact that 20.8% of patients in the PAE arm required a more invasive treatment within 24 mo after PAE because of unsatisfactory clinical outcomes raised questions regarding its long-term efficacy [8]. Here we report 5-yr results from our trial.