Purpose: To evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH). Materials and Methods: A randomized prospective study was undertaken in 80 patients (mean age, 63.9 y; range, 48-81 y) with symptomatic BPH undergoing PAE between May and December 2011. Forty patients underwent PAE with 100-mu m (group A.), and 200-mu m PVA particles (group B). Visual analog scales were used to measure pain, and rates of adverse events were recorded. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires, prostate volume (PV), prostate-specific antigen (PSA) levels, and peak flow rate measurements at baseline and 6 months. Results: No differences between groups regarding baseline data, procedural details, or adverse events were noted. Mean pain scores were as follows: during embolization, 3.2 +/- 2.97 (group A) versus 2.93 +/- 3.28 (group B); after embolization, 0.10 +/- 0.50 (group A) versus 0 (group B; P = .20); and the week after PAE, 0.85 +/- 1.65 (group A) versus 0.87 +/- 1.35 (group B; P = .96). Patients in group B had greater decreases in IPSS (3.64 points; P = .052) and QoL (0.57 points; P = .07). Patients in group A had a greater decrease in PV (8,75 cm(3); P = .13) and PSA level (2.09 ng/mL; P < .001). Conclusions: No significant differences were found in pain scores and adverse events between groups. Whereas PSA level and PV showed greater reductions after PAE with 100-mu m PVA particles, clinical outcome was better with 200-mu m particles.