Does anyone know of a facility or board certified doctor in CA that does FLA or PAE as a BPH solutio

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I have been diagnosed with BPH since 2003 and Avodart and Flomax have not stopped the growth of my prostate. It is well over 110 grams I believe (one doctor used cc's instead of grams and said it was 162 cc). It has now reach critical procedure time and I'm not sure that a TURP is the best choice for me.

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  • Posted

    DCR:  It sounds like you are ready to do something, but I'll post this anyway in case you might want to consider delaying.

    For years my uro said my prostate was about 40 grams based on a DRE.  BTW: For the prostate I believe the general assumption is that 1 gram = 1 cubic centimeter (cc) aka mL.  The density of water is 1 gm/mL.

    Because my symptoms have been getting worse, I recently had a transabdominal ultrasound and it came back at 145 mL.  I just about went through the roof.  I subseqently insisted on a transrectal ultrasound (which is supposed to be more accurate) from my new uro and the result was just under 100 mL. I started avodart and flomax with little noticeable improvement.  About two weeks in, I was switched to alfuzosin.  The alfuzosin has worked much better than Flomax and based on diaries that I've been keeping, I would say that right now my flow characteristics are back to where they were 3 or 4 years ago.  So far so good, and the avodart really hasn't even kicked in yet since I've only been on that for a month.  I'm hoping I can buy more time on the chance that one of the drugs currently in trials for shrinking the prostate by killing prostate cells will be successful and approved by the FDA.  Fexapotide Triflutate is one such drug.  I'll probably need a procedure down the road, but I'd like to have as many options as possible.  Good luck.

    • Posted

      I was originally diagnosed in 2003 and was on both Flomax and Avodart till 2011 when I went the supplement route. Thank you for your insight and advise.
  • Posted

    Yes, Prof. Picel at UCSD performs PAE as a part of clinical study. It's very expensive if your insurance plan doesn't cover it. He performed one on me on March 29, 2108 with excellent results. I am 70 yo and had a prostate of 135 g wit severe retention. I feel now like in my 40th. Don't wake up at night.  It's the best thing that ever happened to me, but make sure it's covered by insurance/Medicare.  It has practically no side effects, could be uncomfortable first three weeks after the procedure.  You can lose your ability to ejeaculate but has no ED or other side effects so typical for TURP or other invasive procedures. The problem is that nobody know how long the positive effect will last. I have  astable improvement after 5 months.  You should start with this procedure, it's best for large prostate. Anything else has high probability of complications at your size. Good luck. There some doctor in LA, at Mount Sinai, who perform it. I just happened to live in San Diego.     

    • Posted

      Gene:

      Do you know if you have/had a large median lobe? I've been reading that PAE doesn't really work if you have a large median lobe. 

    • Posted

      Hi Gene, what Medicare plan do you have that covered PAE at UCSD ? I'm also in San Diego. Will be eligible for Medicare soon. Hank

    • Posted

      Gene,

      Thank you! I'm in Northern CA but would gladly go to San Diego or La if it was the best doctor to do the procedure.

    • Posted

      Hank,  I have Medicare B with Cigna, that covers the rest  20%.  Bills, that are $75K are still in dispute with my "Sharp"HMO, but Dr. told me that Medicare is supposed  to ver them. Some hospitals on East Cost that cover PAE claim that it's Medicare covered.  I am afraid that  Medicare Advantage plan can  deny the claim. It's complicated. There is Government mandate for Medicare to cover clinical trials but there always fine print.  I understand that a doctor in NC perform PAE for $7500 cash.  It's probably the best conservative treatment of BPH ever, if it performed right and works only on a large prostates >70-90g.  It might be expensive in some places and has a lot radiation exposure involved (close to 5-6 CT scans equivalent).  It worked great in my case. I don't think that central lobe size matters much. The whole prostate shrinks and allows the bladder neck work  properly. After 3 unpleasant weeks with frequent urination and some pain fora week, it works miracles for me.    

    • Posted

      Thanks Gene. $75K is a lot of money. Did Dr Picel give you any tests before declaring that you are a candidate for PAE, like prostate size, median lobe, bladder elasticity, urinary retention, etc ? Hank
    • Posted

      Yes, it was transrectal ultrasound, which confirmed what I already new from previous Urography CT scan 135 cc volume and CT angiogram mapping prostate arteries for him during the targeted embolization.  There is no good way measure the central lobe, except maybe for MRI. I had tons of tests over 10 years from my former HMO Urologist, who insisted on TURP or radical robotic operation for years. He doesn't believe in PAE and still call it placebo effect. He is very arrogant as many URo doctors are.  Dr. Picel is an interventional radiologist, not an urologist but underwent 6 month training in NC center.  I studied whatever was available for me on PAE, The latest review papers sound very optimistic.  Nobody knows how long it might last. There stable 3-years old cases. All that said, average TURP rarely last more than 5 years.  I'm a strong opponent of TURP procedure. PAE is widely used in Europe, Israel, Argentina, UK, AU, Brazil. I don't know why the surgery X-Ray room cam out $34,000 for 2 hrs of use. Dr. Picel promised that whole thing will cost less that $12K. I'm still waiting for Medicare approval of Hospital bills but am happy that didn't consent to TURP. In 3-4 years less invasive methods for BPH will be FDA approved and I will deal with that if needed. Currently, I will call myself 95% healthy on the side of prostate issues, no worse than in my 30th. 

      I still hope that eventually Medicare and Cigna will cover the full bill. That's what he promised me. Currently UCSD billing is appealing  my HMO refusal to cover the cost, which is probably justified. They are mandated to cover clinical trials only for cancer or life threatening conditions, when outside of network.  There were at least 12-13  PAE performed by Dr. Picel but I have no idea how they were covered.  Many hospitals claim that the procedure is currently Medicare covered. 

                   

    • Posted

      Thanks Gene. Why didn't you get pre approval before PAE? I sure hope your insurance will pay up. Hank

    • Posted

      I tried. My HMO didn't approve. Medicare B doesn't issue preapprovals.  They have a list of covered services. Technically artery embolization is covered, but question is whether it's covered for PAE.  I was told by the doctor that it was covered by Medicare for previous qualified patients. WE will see. My problem is that Medicare currently is my secondary insurance. They will consider my case after final denial from my primary HMO.  It's a bureaucratic nightmare that is going on for last 3 month. I hope that it wil be resolved somehow. $75K  is of course is a huge price to pay.          

  • Posted

    I was told by Donnie, the nurse for Dr. Karamanian, that there is an Interventional Radiologist in Indian Wells, CA who does FLA for BPH as well as for PCa.  He is Dr. Feller at Desert Medical Imaging in Indian Wells.  Contact information:  74785 Hwy 111, Suite 101, Indian Wells, CA 92210.  Scheduling Phone: (760) 694-9559. His MRI is only 1.5 Tesla, but I was told that he gets very good imaging with it.
  • Posted

    FLA stands for Focal Laser Ablation and is not much different from TURP in side effects but can be used on larger prostate.  It's performed by Urologists, not Interventional Radiologists, who do ownly embolization. Also MRI is useless  for PAE. You can't do PAE under MRI. Yu need a fluoroscopic X-ray with big screen.   

    • Posted

      It’s my understanding that originally FLA was approved by the FDA for treatment of prostate cancer and subsequently for BPH. There are a plethora of interventional radiologists and urologists in Florida and New York who are doing the procedure for BPH
    • Posted

      Hi Gene, so far reports from FLA patients on this forum indicated that FLA has much less sexual side effects than TURP. Recently, long term longevity however may not be as good as TURP, unfortunately. I was looking forward to FLA. Hank

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