Considering PAE. Where to get transrectal ultrasound
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Hello all. 54 years old, recently started having retention issues. Urologist has me on flomax, hated the side effects, now trying Uroxatrol (alfuzosin). While it mostly works, I suspect that I may not be fully emptying my bladder as even after urinating I feel like I should have to go. I can sleep through the night, it is more of a general discomfort during the day.
Anyhow, urologist recommends UroLift although he reiterates that TURP is the "gold standard". Told him to forget TURP. I was going to schedule UROLIFT but am now learing more about PAE and did speak to Dr. Issacson at UNC. Of course, my urologist is not keen on the PAE idea, asked if I really want to be the guinea pig and told stories of problems with AE in general.
Anyhow, Dr. Issacson noted that a good candidate for PAE has prostate of 30g or larger. I have no idea how large mine is. He suggested that a transrectal ultrasound is best way to determine size. My question now is, who does transrectal ultrasounds? I contacted two local "imaging centers" but neither offers this procedure, they said I may need to have it done in a hospital. It seems like it should be a fairly quick in-office type of thing?
And yes, I do feel old as I find myself looking at a forum for "prostate problems"!
Thanks.
0 likes, 24 replies
AZBill MikeinPA
Posted
They don't like 'links' here so here's something from a piece in "US National Library of MedicineNational Institutes of Health" called:
"Accurate determination of prostate size via digital rectal examination and transrectal ultrasound."
It predates Urolift and PAE but seems to predict that the accurate assessment of size is becoming more needed.
"Abstract
Previously, prostate size did not play a significant role in the choice of treatment for benign prostatic hyperplasia (BPH). It has been postulated that prostate size does not correlate with symptom severity, flow rate, or the presence or absence of obstruction. However, in a published study of community-dwelling men, the odds of having moderate to severe symptoms were five times higher for men with enlarged prostates than for those with normal prostates. Response to certain types of BPH therapy, especially finasteride, depends on actual prostate volume. Therefore, it is important to have a simple way to accurately determine if a patient's prostate is enlarged. In an analysis of four studies, there was a distinct underestimation of prostate size by digital rectal examination (DRE) when compared with transrectal ultrasound (TRUS) measurement. The underestimation of prostate volume increased with increasing TRUS volume, particularly if the volume was greater than 30 mL. The average underestimation was between 9% and 12% for prostate volumes 30 to 39 mL and between 17% and 27% for prostate volumes 40 to 49 mL. Because of these results, a prospective study is currently in progress to develop models or visual aids to assist physicians in more accurately predicting a threshold prostate volume via DRE."
AZBill
Posted
AZBill MikeinPA
Posted
They don't like 'links' here so here's something from a piece in "US National Library of MedicineNational Institutes of Health" called:
"Accurate determination of prostate size via digital rectal examination and transrectal ultrasound."
It predates Urolift and PAE but seems to predict that the accurate assessment of size is becoming more needed.
"Abstract
Previously, prostate size did not play a significant role in the choice of treatment for benign prostatic hyperplasia (BPH). It has been postulated that prostate size does not correlate with symptom severity, flow rate, or the presence or absence of obstruction. However, in a published study of community-dwelling men, the odds of having moderate to severe symptoms were five times higher for men with enlarged prostates than for those with normal prostates. Response to certain types of BPH therapy, especially finasteride, depends on actual prostate volume. Therefore, it is important to have a simple way to accurately determine if a patient's prostate is enlarged. In an analysis of four studies, there was a distinct underestimation of prostate size by digital rectal examination (DRE) when compared with transrectal ultrasound (TRUS) measurement. The underestimation of prostate volume increased with increasing TRUS volume, particularly if the volume was greater than 30 mL. The average underestimation was between 9% and 12% for prostate volumes 30 to 39 mL and between 17% and 27% for prostate volumes 40 to 49 mL. Because of these results, a prospective study is currently in progress to develop models or visual aids to assist physicians in more accurately predicting a threshold prostate volume via DRE."
j12080 MikeinPA
Posted
Get a 3 Tesla MRI of the prostate. If read by a good interventional radiologist it will also tell you if they see cancer lesions which are cancer. Then, if you have a single lesion, you can get a single needle focal needle biopsy. Then you have several options including a folcal laser ablation of the Cancer. you need to find this out before a PAE as you cannot be a canidate for PAE if you have cancer. You can find out first with a simple 3TMRI for cancer lesions and it will tell you also the size and density of the prostate gland. No pain or anything in this procedure. Then you decide what to do as Cancer changes the ball game. My MRI showed NO cancer but a dark spot to watch and a huge prostate 125cc. So now I go a differnt direction and it may be PAE for size reduction and BPH relief.
The important thing at your age is preserving you sexaul functions and Focal Laser Ablation is best at that with low to intermediate grade cancer 3+4 gleason or less. All of that will be explained to you if you do have cancer and need a biopsy. All of this is just my opinion I am by no means a doctor.
good luck.
j12080
Posted
Again good luck.
jack08693 MikeinPA
Posted
Mike in Pa?,this is what happens when people are uniformed.Most Doctors and urologists are working from systems that were used before the Internet.Don't settle for any one answer. I recently posted that I went in for a UroLift evaluation and the uroligist told me that I would be a 50/50 cantidate for the procedure because my prostate had grown into my bladder and the part in my bladder my not respond to the lift.So I said what are my options?Is there anything on the horizon to help me?He said that the same people that invented the UroLift are 6 months away from being able to deal with my problem.Keep looking for answers.We are being totally manipulated by the medical industry.So always keep that in mind.
jimjames MikeinPA
Posted
I have read that transrectal ultrasound is the most accurate, but more importantly if that is what the PAE doctor wants then that is the right process since he will be comparing your imaging to previous similar scans.
My understanding is that transrectal ultrasounds are done at imaging centers, often within hospitals, and not at the urologists office. Urologists mostly tend to have portable bladder scanners which are not at all the same thing.
How bad is your retention? Do you know your IPSS score? Have you tried daily 5mg Cialis? If not, maybe try it before opting for an operation or procedure. There is also self catherization that several members here, including myself adhere to. No drugs, no operation, complete bladder emptying and it can also buy you time for better procedures down the road. As a bonus, it may even rehab your bladder to the extent that you can stop the self cathing and go back to pretty normal bladder function. That is what happened in my case.
Jim
Waffalobill MikeinPA
Posted