Over the past 25 years, prostatic artery embolization has emerged as a minimally invasive, organ-sparing alternative for managing benign prostatic hyperplasia. Though once considered experimental, it is now endorsed by major international radiological and urological societies as a valid therapeutic option for select patients. Its clinical efficacy has been proven, demonstrating durable improvement in lower urinary tract symptoms and quality of life. In the last five years, significant progress has been made in patient selection, imaging guidance, and embolic materials. This includes the introduction of liquid embolic agents, which are a promising innovation, but are still the subject of controversy and lack long-term outcome data. Meanwhile, artificial intelligence is emerging as a promising tool to support patient selection, procedural planning, and intraoperative guidance. However, its clinical implementation is still in its early stages. This review offers a thorough synthesis of the latest evidence and ongoing developments in prostatic artery embolization. It highlights significant progress and ongoing controversies, pinpoints knowledge gaps, and discusses their implications for clinical practice and future research.