Considering focal laser ablation and have questions

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I am thinking of focal laser ablation in Delray Beach, FL. I have a very large prostate (250grams). I did my first interview with the medical coordinator I believe. She said that I would be in the MRI for about 1.5 hours. I just read on this forum somewhere where someone with a prostate size of about 176gr was in the machine for over 3 hours! If that is the case will I be in for the whole day in an uncomfortable position? Any help would be appreciated.

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  • Posted

    Hi Gary, interesting that she said only 1.5 hours in mri, my prostate was only about 55grams and I was in mri for approx 3-4hours but I had a large median lobe and needed fFLA on tissue along the prostate urethra as well, what helped me cope being in that position for so long and with bad shoulders is although you are not asleep you are given a sedative which leaves you feeling very relaxed and you can ask to be given more to help you sleep or to move your arms I guess as long as you tell them before you move. I had Dr Karamanian in Houston who is excellent, I flew from New Zealand to have him do it, all went extremely well and so glad I used him to do it, all the best, kind regards Brian.
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  • Posted

    Why did you ever allow it to become so big? I would have thought that  you must have had unbearable symptoms by now. Is FLA really the best option for one of that size?

    The surgeon who did my second laser procedure (135 grms) told me that the biggest he had treated was 300grms. My father in laws prostate was over 200 grms in the mid 1990’s before all the new procedures became available. His health was not good enough to go through a TURP and they first tried a stent before fitting him with a permanent catheter. It would have been very different for him now. His was diagnosed when he had a fall in the street and started to pass blood. When they put a catheter in they got over 2 litres out.   

    There is a good write up on prostate treatments and the FLA procedure on the Sperling prostate center. 

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    • Posted

      I knew my prostate was big, but I did not know how big until recently. My urinary symptoms were manageable until very recently. Why did the fla not take the first time with you? You had to go back. Did the charge you double?
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  • Posted

    Please get an opinion for PAE. With this size, they are going to try and ablate and ablate...and my doc has seen complications that a few have mentioned here from fla. but those websites make it seems like there are none. With the prostrate being that big, you will need a pae or removal. My doc did my pae and have been great ever since. 45 min, nothing put through my rectum or penis and results are great!
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    • Posted

      Sam, I researched the pae procedure and I found out that the amount of radiation that you are exposed to is astronomical. For example you are exposed to an average of 265 rem. A 1,000 rem dose is lethal. I am 68, so if I live another 20 years it gives that amount of radiation time to do damage.
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    • Posted

      "Look in to research and publications on FLA and BPH and there is a reason you will not find anything." Please elaborate on this for me. I agree that there is much less info on BPH and FLA than for cancer. But why?

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    • Posted

      It seems that FLA is talked a lot about, but when I looked in to it, my doctors told me that there was not evidence to show that it works for BPH and that some people are just using it to try. This could work, but we don't know and taking that in to account was important for me

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    • Posted

      I am not sure I know what you're talking about in terms of dosing, but radiation is part of any procedure like PAE. I would check on what you think the dose is and what the effects are. I am not an expert on this, but it seems that the numbers you are quoting don't make much sense for these types of procedures when we get radiation if we have ct scans, etc...would ask your doctor or a radiologist

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    • Posted

      As I understand it FLA was developed to treat prostate cancer and would be treating areas within the prostate not creating a path through it. Dr K and others have refined it for BPH but from recent posts it can leave pockets that fill up with something. IS it approved by the FDA ?
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    • Posted

      Yes, FLA has been approved for treating several forms of cancer in different organs and has been used for many years in the US and other countries. I think some of the confusion around this treatment is because there isn't (yet) and insurance procedure code for it, which means most insurance will not cover it. As a result, that reduces the number of men who have had the treatment and the results which insurance companies (and Medicare) use to validate the efficacy of the procedure. All new procedures go through this process (PAE, Rezum, HIFU, etc).

      FYI: I had FLA performed in Dec 2017 and researched it (and every other treatment available) for the 5 years prior. I chose it because it could treat both prostate cancer and my urinary symptoms, which makes it unique in that regard among the different procedures.

       

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    • Posted

      In America is a doctors recommendation for  types of treatment accepted or do insurance company doctors have the final say?

      At the moment cost will be ruling out FLA and possibly PAE for many.

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    • Posted

      Very complex question:

      As far as payment for FLA goes, Insurance companies dictate how much (if anything) they will pay/reimburse for that treatment. Simply because the FDA says it's 'legal', does not mean it is 'medically necessary'. It tends to be a long arduous path for new treatments (and drugs) to get approved and in the system.

      There have been a few (very few) men in the US that have received some payment/reimbursement for FLA, but the majority receive nothing.  I received nothing - but I went into it knowing that would be the case. Most (all?) new procedures face similar hurdles - though drug companies and equipment manufacturers will conduct studies that may pay all/part of the treatment. Other than a few small studies on FLA for prostate cancer that have been funded by the NIH (national institute of health), the majority have (best of my knowledge) been paid out of pocket by the patients.

      Hopefully, in the not too distant future - FLA will be approved by Medicare for PCa and BPH - at which time that will open it up for most. 

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