Focal Laser Ablation / Prostate Cyst - New Member Dr K Club

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Add me to the Dr K Club. Yesterday Dr Karamanian with his professional nurse assistant Samantha (Prostate Laser Center Houston TX) used FLA (Focal Laser Ablation) to help me with my problem. I'm resting comfortably in my Houston hotel room as I type this. I discovered FLA and Dr. K on this forum while researching early in the year and wanted to give back by posting my experience.

Quick symptom background- weak stream ever since I can remember, worsened some over the past few years along with nocturia (2-4 times per night). I was scoped 20 years ago, found nothing and went on to Alfuzosin. Scoped again 10 years ago, "bladder neck obstruction", still small prostate (30 grams), mild BPH.

Fast forward to beginning 2017 when I once again undertook my every 5-10 years review of what's new in treating prostates. Wow, lots of new stuff. PAE immediately caught my eye, Tried to get into the Stanford PAE trial of Dr. Gill but did not meet criteria (too small prostate). As it turns out this was a blessing in disguise! During my TRUS there they made no comment about my prostate other than small.

I followed up on another procedure that caught my eye, FLA, and contacted Dr Karamanian. He arranged for a 3T MRI where I live (1500 miles from Houston). The MRI results were stunning to me as #1 there was a cyst right at my bladder neck and the top of the prostate. Well hell that would explain my symptoms eh? And the only way I could have ever known it was there was by having the MRI! (or a skilled ultrasound operator seeing it) #2 Secondarily, there was an area of my prostate that looked very suspicious (possible tumor).

Dr K reviewed the local MRI scans that I uploaded to his website (easy, convenient, quick) and suggested I have a TRUS biopsy to identify if the suspicious area was malignant before we went any further. This I did locally, and thankfully all 14 biopsy cores were normal. Just looked bad on MRI and this happens not infrequently.

With this out of the way I scheduled my appointment with Dr K to have the cyst and some prostate tissue ablated. First attempt to get down there was thwarted by the monster hurricane a few week ago that flooded Houston. I rescheduled everything and got the FLA done yesterday.

Everything you've read about working with Dr K is true, he is a skilled, innovative, caring, accessible interventional radiologist, and his nurse Samantha is a jewel by any measure. My procedure yesterday went off with no complications and thanks to the very nice people doing it, I had nearly no anxiety.

I won't know initial results until next week when I remove the Foley catheter, and of course the full results for another 6-8 weeks after all the swelling and ablated tissue is absorbed. But I have a lot of confidence in a great result, and even if for some bizarre reason I don't, I've not caused irreversible damage/side effects, as FLA (skillfully done!) apparently has none (RE, incontinence, impotence, etc).

The lessons to pass on here to other readers are:

1. Get a 3T MRI before you do ANY procedures on your prostate, otherwise you don't really know what the hell is going on! Ignorance is not bliss. If not 3T at LEAST have a TRUS (trans rectal ultrasound) done by an operator who knows prostates!

2. FLA for BPH and other amenable problems like cysts/tumors is a compelling value proposition. When FLA is done by a skilled and competent practitioner it has an extremely favorable risk profile. I would suggest FLA is a very technical procedure requiring both art and skill, far more so for example than jamming a tool into your urethra to staple the prostate walls back. I could see where FLA outcome would be very dependent upon who is doing it!

3. Everything you read about Dr Karamanian is true, he's an awesome human being and he has a gift for what he does. That is a rare combination and "we" are very lucky to have him out there working his magic. He took all the time needed at every point of the process.

Not sure yet if insurance will pay for it, I filed for a pre-authorization and they approved it, so looks good for reimbursement. Dr K does not file or take insurance and you will have to pay him upfront which is what I gladly did. If insurance does not pay it's still the best money I'll ever spend.

We all have our individually unique physical challenges, after 40 years I think I finally found the fix for mine, and I wish only the best for anyone suffering who reads this.

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  • Posted

    Pete, congratulations on the operation and welcome to the K Club! Be patient now and you will see progressive improvement. It took 9 weeks for me to consider myself right as rain! I've almost forgotten I ever had BPH.

    Pete Kline

    Hong Kong

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  • Posted

    Thanks for sharing your experience pete. Glad your happy with your experience so far. You mentioned you filed for a pre-authorization and they approved it. Would that cover the whole procedure or just part? 

    Unfortunately getting a 3T MRI isn't all that easy because most urologist won't prescribe it. I asked mine for one and was told it wasn't necessary. 

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    • Posted

      Thanks to all for the comments.

      Insurance: good question, and at this point I do not know the answer. Will update when I find out.

      Yes, urologist in my experience want to cystoscope you and not use any other diagnostic tools like TRUS of 3T MRI. At the end of the day they want to get paid and only way to do that is with a 'scope when other tools could be deployed. Good for the uro, bad for the patient. The older I get the more I realize that I MUST be my own health advocate and director of my own care. Shame eh?  

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  • Posted

    I don't understand why more interventional urologists are not doing this, as it would appear to be the way to go for BPH & low grade prostate cancer.

    Does anyone know of this procedure being carried out in the UK?

    Is a special MRI machine needed or is just a standard machine used?

    Once the swelling has come down you will feel just like a teenager again!

    All the best. 

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    • Posted

      IR's are getting more involved but in the end its a cost issue. Insurance for now isn't paying and many men can't swing $20K+ for a procedure or are reluctant to pay out of pocket for a procedure who's durability is unknown. Imagine paying $20K and needing to have it done again in 2 years eek Not saying thats going to happen but it is a concern. I was gun ho until my slush fund for FLA got gobble up by a major unavoidable house project. Life isn't fair sometimes. That said my BPH symptoms are mild compared to most men that frequent this forum. For that I am very thankful

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    • Posted

      Thank you for your kind comments!

      Let me clarify please: 

      1. Urologist.

      2. Interventional Radiologist.

      Two completely different kind of physicians! cheesygrin Dr. K is a very special IR (not a urologist) as he is will to accept the challenge of providing what most would consider non-standard treatment. He's got a great video on YouTube anyone interested should watch to get an idea of where his head is at. Very rational, analytical, thought-out approach that very much appealed to me. 

      Yes, agreed, the more diagnostic testing the better in my opinion! How the hell does a urologist really know what is going on if he does not image the gland? I'm sure it is to save money for the insurance companies and to make money for the urologists (they do have to eat to) but at the sacrifice of truly understanding what the patient has going on! We must be our own health advocates, and this forum seems to be a good lace to separate the BS from true success stories. 

      I'm proof that if my prostate had been competently imaged decades ago I would have known then what I was dealing with! Thankfully I refused to have any damaging procedures done. Other men have of course not been so fortunate and I do feel very sympathetic towards their situation.

      3T MRI is current state of the art and should be demanded vs 1T MRI. Otherwise "standard". 

      Onward upward! 

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    • Posted

      Great advice Pete, I am looking for a 3T MRI near me now.  I was scheduled for a TURP this past Wednesday and decided to wait and look for an alternative. I felt I was getting rushed but maybe it's because of my symptoms. Holding up to a liter in my bladder for who knows how long has probably done some damage to my bladder and my kidneys. I am self catherizing 2 or 3 times a day until I feel I know all the alternatives. My urologist just mentioned Urolift as an alternative but didn't think it was the best for me. I thought I was in great health at 53 and can't believe I am going through this. The bad thing is I am led to believe I have damaged some of the nerves in the bladder. Again, thanks for the MRI advise, hopefully that can confirm for me what's going on with the prostate.

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  • Posted

    Sorry, I meant to say Interventional Radiologist, rather than Urologist.
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    • Posted

      No worries! cheesygrin

      The terminology can be challenging for laypeople so it was a good opportunity to clarify things, so all good.

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  • Posted

    Pete is the $20,000 a complete cost or just Dr. k's fee?

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    • Posted

      George, my cost to Dr K was us$22000 all up. This did not include all meds, which were not expensive, or my hotel but all visits to the doctor.

      I hope this helps.

      Pete

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    • Posted

      Multiple Pete's here but that is fun!

      Like Pete in HK, my procedure was in the $20k's (paid up-front). Add your prescriptions cost, travel cost, hotel cost.

      Now, the Prostate Laser Center lump-sum fee includes Dr K and the (critical care) nurse Samantha's magic, the MRI facility use, all the ancillaries (catheters, bags, IV, syringes and injectables, the followup visits, etc etc), so that is a bit different from where the doctor and imaging center bill you separate for all the bits and pieces, so it could be thought of an an all-inclusive fee.

      Frankly I looked at it as a rebirth event in my life (most of you understand) and shelled out for a nice hotel and comfortable travel to make the most of it. Furthermore I looked at all of it as a personal investment in myself rather than an expense. Amortize let's call it $25k over the next 40 years is $625 a year for a properly working and fully functional prostate! Priceless in my opinion? Gives you a different attitude on the whole thing.

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