Any bad results from prostate artery embolization?

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My family doctor was all for PAE until she checked with another doctor in the practice when she changed her mind.  She says there is a large danger if blocking the wrong arteries feeding either the bladder, rectum or both, obviously leading to very serious issues.  This could lead to surgery possibly having major consequesces.

Has anyone encounter such issues and did the doctors performing the procedure address the possibities beforehand.

I was ready to have the procedure but am now also looking into MRI guided prostate ablation----has anyone had that performed?

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  • Posted

    Hello Richard - I had PAE in August by Dr. Isaacson at UNC in Chapel Hill. I have a very prostate (280gm) with no median lobe so I was considered the ideal candidate. The doctors who perform these procedures are well aware of the risks you mention which is why they stay away from the transitional zone near the urethra when they embolize. But it is a risk though a very small one.

    My PAE went well and my prostate was reduced to 175gms after 3 months though my symptom improvement is not there and I still have to self cath.

    I had a 3T-MRI a month ago to see if the PAE was effective in reducing blood flow to prostate. Apparently it was but the MRI also showed a suspicious lesion near the capsule which is thought to be cancerous. I will be having an MRI-targeted biopsy with Dr. Karamanian in Houston in 2 weeks. The lesion is very small (7mm). But I mention this because there is some evidence that the PAE procedure can "awaken" otherwise indolent tumors because their blood flow has been cut off. So these otherwise quite lesions suddenly start aggressively looking for blood vessels. I don't know if that is what happened with me and I don't mean to scare you but it is something quietly talked about which you wouldn't hear from the doctors.

    Regading FLA for BPH, that is Dr. Karamanian's expertise and I will discuss it with him when I  see him but I am quite satisified with CIC (self Cath) into the future.

    Good luck with your decision.

    Neil

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    • Posted

      Hi Neil

      Originally Artery embolisation was used to treat tumers and cancers. If your read one report published by the American Cancer Society about embolization of cancerous liver you would know that embolization cuts blood from cancerous organs so cancer cells do not grow, rather they die. However, you said your nodule is now 7 mm after 4 or 5 months since you had your PAE. To me it's an indication that it has been shrinked to this very small size instead of grew to this very small size. That's my opinion presuming you haven't had an MRI before PAE. All the best

      FJ

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    • Posted

      Hi FJ,

      I hope you are correct!! I originally thought as you did which is why I brought this up to an IR I know. He then scared me when he said that that is true when the tumors are actually targeted by the embolization. But they do have evidence that quiet nearby lesions that may be growing very slowly and would never be a problem in our lifetime suddenly become aggressive when their blood supply is reduced. He told me this is "the little dirty secret about PAE".

      Anyway, next Wed. is my biopsy with Dr. Karamanian and I pray it is just a granuloma. I really like him and if needs be I will use him to remove the lesion by FLA. All the best to you.

      Neil

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    • Posted

      Hello Neil,

      Please provide evidence or study Pae causes PCa lesions to become more aggressive in search of blood supply.

      Thank you

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  • Posted

    I asked dr bagla who did mine about this and this seems to be mainly a scare tactic by urologists. It's rare to have a complication from pae and you should see someone experienced

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  • Posted

    I think the reason she don't what you to have it is because a urologis does not do it.  If that is what you want go for it.  A lot of men on here have had them and they are fine..  Ps.  Not into women doctors.  Talk with some men that have had a PAE done. Ken

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  • Posted

    I have to agree with Sam on this. The chance of the wrong arteries being embolized are very remote. Any procedure can go wrong, but the odds are as good or better than any of the surgerys where nerves, arteries or other can be nicked by mistake. I am going on 20 months now since my PAE and my results are still outstanding. It was the best decision iI ever made.
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  • Posted

    Hi Roger,

    I had all the symptoms of a enlarged prostate and I was considering the PAE procedure but then found out I also had prostate cancer. My urologist recommended a radical prostatectomy but after my research I decided to have the HIFU procedure which took care of both the cancer and the symptoms associated with having a very large prostate. I am totally back to normal and can urinate with no issues. I Sleep through the night also.

    The urologist who did my procedure used to do the laser ablation but found the HIFU procedure to be more controllable and accurate. Downside is the procedure is not covered by insurance and cost $25,000 which is way more than the PAE procedure.

    I have not heard of the issues you have mentioned actually happening in a PAE procedure but I'm sure it is possible. Just go to someone with a lot of experience. Also checkout Urolift.

    You need to match your symptoms with the best procedure for your specific case.

    Hope this information helps.

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  • Posted

    If you have a competent doctor, that should not be a problem. In any surgery, you want to find a surgeon who has done many many of them successfully, e.g. get. the best, most experienced person you can find, even if you have to travel a significant distance to get to where they practice. I don't know about Britain, but here in the States, that would be Dr. Bagla in northern Virginia, or Dr. Isaacson at UNC.

    Remember that the PAE is performed by an interventional radiologist, not a urologist, so it will seldom be recommended by a urologist, since they make no money on it. Urologists make their money doing one, or another, kind of TURP, so that's what they usually recommend.

    Neal

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    • Posted

      just for information.  Found a site today that compares various individuals or organization doing PAE. It also stated all the issues with it and what can go wrong.. It was done by Franciso Cesar Carnevale Md. PhD. He is the guy in Brazil that studied under Pisco before starting the procedure in Brazil 

      Look up FEST 2016US  then under Complications after PAE by Carnevale .. found it using Foxfire 

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    • Posted

      Dr Bagla did my pae over a year ago and he pioneered this in the US at the same time the docs in Brazil and Portugal were just getting started. If you want to get more info, call the interventional radiologist closer to you and ask questions. Overall, the chance of something going wrong is many times less than with other options that urologists do. My only advice is that the really experienced ones know how to make sure ur results are best and are successful in doing the procedure 
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    • Posted

      Sam had the PAE procedure 2 years ago. I believe the site I suggested to look up if you want comparisons also included Dr. Bagla. They all appeared to have had result issues. You should check it out. 
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    • Posted

      Hi Ed,

      I finally found it looking up Complications after PAE by Carnevale.

      Any procedure can have complications, and so can PAE. Some, such as Foley catheter placement are irrelevant. If your doctor places a catheter absent other complications, he/she doesn't know what they are doing. I have had 3 PAEs, and never a catheter with them. If your doctor wants to use a catheter, tell him/her to use a urinal or bottle, or get a different doctor.

      Some of the "complications" aren't really, such as blood in the seminal fluid. That means that the PAE is working as it should, and some of the prostate is going away as it should be. It's kind of similar to a woman bleeding a little when she looses her virginity. It's expected. This is very temporary, and causes no problems.

      Some of those complications are serious, but, thankfully very rare, and can mostly be chalked up to errors by the doctor, or previous unknown complications such as a tickey heart. I once had a nurse almost kill me by trying to connect an IV to my arm when the IV rig was full of air. My former wife, a nurse, saw what she was doing, and stopped her. A hospital is a dangerous place. Go to a good one, and go to a very experienced IR to get a PAE done. The serious complications of a PAE are much rarer than the complications of the "gold standard" TURP.

      Don't forget that having a lot of urine back up in your bladder and kidneys can, and will, eventually, kill you.

      You have to look at all of the data and find the procedure that has the most benefit with the least likelihood of serious complications. For me, that was the PAE.

      Neal

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    • Posted

      That is why I chose PAE over two years ago. But one looks at all the information around. I will need to have it done again in a few years.. Love to have comparative information for my next PAE
      Report Reply

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