Prostate artery embolization is emerging as one of the most effective therapies amidst a new era of minimally invasive benign prostate hyperplasia treatment and technology. However, several current controversies remain unanswered which could impact the widespread adoption of this novel and unique transarterial (rather than transurethral) intervention. This is reflected in the differences between the UK (NICE), European (EAU), and American (AUA) guidelines, the latter of which only recommends the use of prostate artery embolization in a clinical trial setting. The main issues include questions over the duration of symptom response, cost-effectiveness, mechanism of action, patient selection, and other procedural technical considerations. These factors are the most pressing faced by proponents of prostate artery embolization, and we seek to highlight why their resolution is important to ensure men with benign prostate hyperplasia seeking a minimally invasive solution are optimally informed and most effectively managed.