Prostate Artery Embolization (PAE) for Lower Urinary Tract Symptoms (LUTS) Due to Benign Prostatic Hyperplasia (BPH)

Inclusion Criteria: Inclusion Criteria: * Male, 45 years or older * Diagnosis of Lower Urinary Tract Symptoms from Benign Prostatic Hyperplasia refractory to medical therapy for at least 6 months. * IPSS score at initial evaluation should be greater than 12, and uroflowmetry (Qmax) of \<15mL/s (milliliters per second). * All prostate volumes will be \> 40gm * PSA which meets one of the following criteria:Baseline PSA ≤ 2.5ng/mL, Baseline PSA \> 2.5 ng/mL and ≤ 10 ng/mL AND free PSA ≥ 25% of total PSA (no biopsy required);Baseline PSA \> 2.5 ng/mL and ≤ 10 ng/mL AND free PSA \< 25% of total PSA AND negative prostate biopsy result (minimum of 12 core biopsy) within 12 months;Baseline PSA \>10 ng/mL AND negative prostate biopsy result (minimum of 12 core biopsy) within 12 months;Negative prostate biopsy (minimum 12 cores within 12 months) if abnormal digital rectal examination. Exclusion Criteria: * Patients with active urinary tract infections or recurrent urinary tract infections (\> 2/year), prostatitis, or interstitial cystitis. * Cases of biopsy proven prostate, bladder, or urethral cancer. * Patients on long-term narcotic analgesia, androgen therapy, or GNRH (gonadotropin-releasing hormone) analogue therapy who are unwilling to stop therapy for 2 months prior to the study. * Use of anithistamines, anti-convulsants, and antispasmodics within one week of treatment unless they have been treated with the same drug (at the same dosage) for at least 6 months and has an associated stable voiding pattern. * Patients who are classified as New York Heart Association Class III (Moderate), or higher, have cardiac arrhythmias, have uncontrolled diabetes, or are known to be immunosuppressed. * Hypersensitivity reactions to contrast material not manageable with prophylaxis. * Patients with glomerular filtration rates less than 40 who are not already on dialysis * Prostate volume \<40 mL * Patients with bilateral internal iliac arterial occlusion * Patients with causes of bladder obstruction not due to BPH (eg urethral stricture, bladder neck contraction, etc) * Patients with neurogenic or bladder atonia * Prior prostatectomy * Cystolithiasis within the last 3 months * Patients interested in future fertility * Patients with a life expectancy less than 1 year * Patients where embolization is not possible distal to collateral vessels feeding non-prostatic tissue * Patients with major neurologic illnesses which could have symptoms that may be similar to or confused for BPH (eg Parkinson's disease, multiple sclerosis, Shy-Drager syndrome, spinal cord injury, etc.). * Patients with urethral stents * Patients who have undergone prior rectal surgery other than hemorrhoidectomy or pelvic irradiation. * Patients who have started or changed their dosage of alpha blockers or 5-alpha reductase inhibitors in the month prior to PAE