Neoadjuvant Embolization and Cytoreduction in Prostate Cancer

Inclusion Criteria: * Histologically confirmed prostate adenocarcinoma with planned RT to the prostate * Baseline (pre-PAE) prostate volume ≥ 50 cc * Baseline (pre-PAE) IPSS ≥ 15 * If planned or ongoing ADT and/or 5-alpha reductase inhibitor (5ARI), patient should be on therapy for at least 12 weeks, and meet prostate volume and pre-PAE IPSS criteria at the time of enrollment. Exclusion Criteria: * Baseline (pre-PAE) IPSS storage/voiding ratio ≥ 1 * Previous prostate treatment (TURP, Laser therapies, MISTs) * Chronic urinary retention requiring use of indwelling urinary catheter. * Neurogenic bladder or other neurological disorder that is impacting bladder function (e.g., multiple sclerosis, Parkinson's disease, spinal cord injuries, etc.). * Active urinary tract infections or recurrent urinary tract infections (\>2/year), prostatitis, or interstitial cystitis. * Receipt of beta blockers, antihistamines, anticonvulsants, or antispasmodics within 1 week of study treatment AND patient has not been on the same drug dosage for 6 months with a stable voiding pattern. * Hypersensitivity reactions to contrast material not manageable with prophylaxis. * Glomerular filtration rates less than 40 mL/min (unless on dialysis). * Bilateral internal iliac arterial occlusion.