Going with Focal Laser Ablation for BPH

Robbie, I will try to answer and clarify to you what you asked. First, this is not a medication. It is an enzyme supplement product.  I bought my product at the local health food store.

Second, I did not take this specifically for my prostate as my prostate seems fine after the FLA treatment has fully healed. I learned of this product from the post that Steve place on this tread about three weeks ago.  I did not take this supplement specifically for my prostate though I feel that it will work the same for the prostate as it does for all the issue I specifically took it for. That reason is INFLAMMATION. And I have a lot of it all over my body. Neck, shoulders, back, ribs, prostate. One hand and one foot. Yep, I got inflammation and it hurts especially when I sleep.

My inflammation is chronic inflammation. I am not in favor of taking NSAID even though I use to take them and occasionally must have one now for a golf tournament. I don’t like the side effects caused by them. I will not take pain medication because if I did, I would be hooked on them as I need them 24-7 for the issues I have had. When I was young and caused most of my inflammation by injuries from accidents, I use Scotch and Quaaludes to get though the healing process and the pain to keep on going at that time. Obviously, this was not smart. The gift for that decision and life style was a lot of inflammation for the rest of my life.

In direct answer to your question, if you have prostatitis and it is not bacterial, or even if it is, I think this product, Serrapeptase, could help that as prostatitis whether it is chronic or bacterial, it is Inflammation and my inflammation everywhere seems to be dramatically reduced.

 I am sure if this would help someone after a procedure for BPH like FLA and especially Rezum. But it seems to me that the inflammation after the treatment could be attacked with Serrapeptase enzymes. I would first check with my doctor preforming the treatment. Rezum must cause a lot of inflammation as they punch holes back through the urethra to shoot the hot steam into the gland and inflammation is a natural result after the healing from the punches are complete.   

I will say that Serrapeptase has been in the market for over 20 years and several studies have come out of Europe.  The long-term effects of this has not been clinically established. But, I don’t really have a long term left in my life so I am willing to take this product for now for the relief I am getting. I plan to cut back after tomorrow’s dose and go to three days a week to see if I get the same results I am getting now from one pill a day. It is trial and error and I will figure it out as I go. I also take Curcumin and Tart Cherry juice twice a day for inflammation and they helped me but not to the degree that Serrapeptase has in this short period I have taken it.

You or anyone considering any supplement should do your research to make your decision.

thank you so much for taking the time to explain everything so well.  I appreciate it immensely.

I too have lots of pain... everywhere. I have severe arthritis and it just gets worse. and..I'd love to solve my prostate problem .. I don't have that many years left either, I'm 74,  i'll probably try this supplement for both my prostate and the pain... can't hurt.

thanks so much again for your time.

Robbie

I guess I wrote a little to soon. I just re-read your post to me that said your not taking it for prostate ...but for pain and inflamation... since I have a ton of both ..maybe it would help. Is it helping your pain as well as your inflammation? I apologize for not remembering what you advised.

Robbie

I've been taking Serrapeptase for about a month. 

Very marginal improvement with the prostate.   I'm voiding 400-500 cc more frequently but LUTS not changed much. 

However, both knees feel better, my neck hardly hurts anymore and my low back pain has lessened.  I am happy with that. 😊

Michael

That's a start Mike  Ken

Hi Michael- If you are noticing marginal improvement with your prostate, that is very good after one month. It probably took 10-20 years for your prostate to reach its present occlusion, so keep going..! It also takes about a year, from what I have read about serrapeptase, to  clean out your arteries... another [potentially] great side effect. 

Cheers- J 

 

Martin very happy for you.  Have a great day  Ken

Fabulous news Martin!

Ken

Not sure who can answer this but perhaps you can. 

FLA is not going to happen.  I needed my wife's permission to take equity out of the home to pay for it.  She said no way, that my insurance pays for partial prostatectomy or TURP, and I'm selfish to not go with the insured procedure.  

Now I'm thinking of Urolift and maybe Finasteride to buy time. 

If I have Urolift do I need the hardware taken out before FLA?   That strikes me as absolutely necessary.    

Other than taking out the clips there's nothing that would prevent FLA later, correct?

I'm hoping maybe insurance will cover FLA in two years, then I can see Dr K.  

My urologist is one of the world's top prostate surgeons and I have all the confidence in the world in him.  But it's still major surgery.   Even if FLA fails, I can always do the partial RP later.  

Thanks

Michael 

Hey there Mike.  The Finasteride would by you some time and maybe the Urolift will work.  It would not stop you from having any procedure done The string and the one clip can be taking out and the anchor stays in but can be cut out with the laser if you go for FLA or any other procedure  Ken.

I asked Dr. K prior to my FLA if he could do an FLA after someone first had a Urolift, and he said he wouldn't do it, that the filaments would get in the way and cause an MRI occlusion. He may have changed his mind since then though. It would be best to ask Dr. K if his opinion about that has changed. (It's also best to keep in mind that most of the FLA failures [5] have been on men with a prostate size less than 45cc's. Nearly all of his FLA's have been successful [except one] where the patient has a large occluded prostate.)

Cheers- J

Thanks Jay.  I will send him a e-mail.  I know that I have no problem with having a MRI  It's on the back of my card. Had one last year.   Yes it does seam like the larger prostate are doing better with FLA  Thank you  Ken

Jay: (It's also best to keep in mind that most of the FLA failures [5] have been on men with a prostate size less than 45cc's. Nearly all of his FLA's have been successful [except one] where the patient has a large occluded prostate.)

-------------------------

Jay, I know you're presenting this as anecdotal, but for those not as familiar, this can not be emphasized enough that all we have with FLA for BPH is a handful of anecdotal accounts with no trial study data. But given these limitations in mind, the results are no better than Rezum, a more established and studied procedure that is covered by isurance where FLA is in most cases not.

As to beaking down FLA results by prostate size, again I don't think we have nearly enough data to draw any meaningful conclusions here.

Jim

Mike, you can get by by taken dutasteride. I had been taken it for about 4 month until I learned that the FLA even exited. I didn’t want to do TURP and for uroloft first me prostate  was too large second I really didn’t feel good about it. It was  a difficult deceision to make as the procedure cost lots of money. Today after 5 weeks I feel really good about my decision. Money comes and go but we have one life to live. As far as I know 99% of us who went with FLA are very happy. Do not go with TURP I have read lots of negative results and although it could go welll I didn’t want to play Russian roulette with my life. Hang in there hopefully the procedure will be approved some time in the nearest future or talk to your wife she may change her mind if she knows how much it may change your life. 

Hi jimjames- Of course it's all anecdotal. Five anecdotal cases with similar prostate profiles [45cc or less], all with similar poor results.

Also, I have read posts from you in the past that presented the 'smaller prostate' FLA model as having more problems than the larger prostates. Have you changed your mind in this regard..? If you have changed your mind, what is the basis for your change of heart..?

Hi vic... just wondering what your prostate size was pre-FLA..?

Cheers- J

Jay: Also, I have read posts from you in the past that presented the 'smaller prostate' FLA model as having more problems than the larger prostates. Have you changed your mind in this regard..? If you have changed your mind, what is the basis for your change of heart..?

-----------------

Hi Jay, My memory is far from perfect, but this just doesn't ring a bell. Can you please refer me to one of these posts so I can properly respond. You may have me confused with someone else, but even if so, I would be happy to review the article although frankly I don't understand how such an article can exist given there are no published studies on FLA for BPH that I'm aware of.

Jim

Vic: As far as I know 99% of us who went with FLA are very happy.

------

Jay had 5 failures out of 18, I have 6, but in either case that is far from 99%, closer to 70%, which may not be as good as Rezum or some of the other non invasive procedures.

Jim

My Prostate size was 125

I was on this forum for awhile before and after my FLA. I went to dr. K and as far as I know he had one case where the penis head went num. I believe he had no other negative cases. I can’t speak about any other doctors who may practice the same procedure 

Vic, No, these were all Dr. K's patients. To the best of my knowledge, all the FLA cases here were done by Dr. K. other than John's which was done by a collegue of Dr. K., Wasser (sp?) I believe. It's all in the FLA threads if you want to take the time to review.

Jim

Vic it is great to hear you are doing so well. Also nice to hear from Martin Victor.

I am now almost two years out of my procedure. I am doing wonderfully well. Actually, better than ever. I am taking the Serrapeptase and it has actually helped inflammation all over my body.

 

I did call Dr. K for a follow-up and he is very busy now he has done over 100 FLA procedures now. He is now much more proficient but he said he still takes a long time in the procedure. He said he always will. Most of his patients are not on this forum.

It was also great to hear about Martin Victor. I could not happier to hear this as I know what a blessing it has  been for me  

Vic it is great to hear you are doing so well. Also nice to hear from Martin Victor.

I am now almost two years out of my procedure. I am doing wonderfully well. Actually, better than ever. I am taking ……

I did call Dr. K for a follow-up and he is very busy now he has done over 100 FLA procedures now. He is now much more proficient, but he said he still takes a long time in the procedure. He said he always will.

Most of his patients are not on this forum.  Even most of the guys who have been successful and previously used this platform have stopped responding to this forum. Many reasons.

Example My original message to you was block as I mentioned the name of the enzyme I am taking which has been a great addition to stop all the inflammation all over my body.

It was also great to hear about Martin Victor. I could not happier to hear this as I know what a blessing it has been for me  

Thanks Vic.

I will ask my Urologist this week about ordering the Finasteride.  I try natural stuff, like DIM and Serrapeptase, but need to halt the enlargement process.  For all its side effects, Finasteride does slow down DHT conversion.

FLA isn't on the table for me.  My wife has said she will not go into debt over my selfishness....that is, if my insurance covers TURP and partial prostatectomy (major surgery), then I should not pick a procedure (FLA) that is out of network.  Also, we both own the home and to take equity out, she has to sign the papers.  Not going to happen.

I'd like to buy time, hoping some trials on FLA might get insurance carriers to cover it.  That could be 2019 or 2020, if it ever happens.

I haven't looked into insurance and PAE.  But PAE just doesn't sit right with me.  I spoke briefly with one of the top PAE practitioners in the US, but it was a hurried conversation that lasted less than 5 minutes.  I can't make a decision on such a short conversation, especially when I had more questions to ask but wasn't given the time.

Lastly, from what I've read there is now some evidence that perhaps Finasteride doesn't raise the odds of > Gleason 7 cancer after all, as was proposed in the findings of PCPT.

Michael

Jim,

It would be nice to have a larger database than 18 patients, and to have results (IPSS, QoL, void rate, prostate volume) tracked over 2-3 years.  

I wonder, if 70% is the actual success rate - even allowing for a larger patient sample size - how does that compare to TURP, PAE, HoLEP, Rezum, and other procedures?  Also, there has to be some quantification of what "success" means, more than anecdotal "evidence."

I've talked to two guys who had FLA - one for BPH, one for cancer - and both could not be happier.  It would be helpful to see a published report.

I heard Dr. K is planning on doing that.  I'm not aware of how close that is.

Thanks,

Michael

Hey Jim, you are correct it is FAR from 99%. I wish Ihad never had it done, and so does my brother.

John, I’m glad you are doing wonderful and I’m glad it has been already for two years. There were some speculations it may not last for life time since there were no long time studies available. 

Good morning.  Mike.  I hope your doctor give you the med's so you can but some time to research more.  As you have told me Turp is off the table.  You should never do a procedure that will be cover by insurance if that is not the one you want. That choice will all ways be in your head.  Was that the right thing to do.  Good luck.  It was nice talking with you yesterday.  Have a good week  Ken.      

Sorry to hear that Joe.  So you and your brother had FLA's.  Did they tell you why it did not work???  Ken

HI John  ,

Many thanks  for your  great   activity .  Mentioend  enzyme is very  helpfull for me ,too. My dossage is 500.000  daily.  Together with  12 days of total  fasting, it  cured me from  begining  prostatitis in  2 months .  I wrote  details on other tread . 

..................

 So you have  info  from Dr.  K that he has more then  100 FLA  procedures  already ? It will b e interesting  when the results  will be available to public. .  

In my  Excel  file with detailed info  I have  just 23  patients.  3 failed , 2-3 mixed results . The rest are very happy  men  describing  FLA as changelifer, icluding me.  I mean  without any side effects. 

I wish to all sufferers to be FLA covered by insurance companies soon.   

 Best Wishes from Europe , Stan     

Joe,

I'm sorry to hear FLA didn't work for you and your brother.  Has your condition worsened from it?  Did the doctor who performed it say he can do anything to correct it?

It's disheartening that after weighing the options, you pick one with high expectations only to find it did not work.

Any procedure with 99% success would immediately become the go-to procedure, even with insurance companies refusing to pay for it. 

I wonder what the best procedure is, and if any offer success above 75%.

Michael

Stan,

From your sampling of patients, that would be a success rate of between 74% and 78%. 

I would doubt TURP or PAE approach those figures.  I would like to see results for HoLEP, which I imagine would show a high % of success with someone as skilled as Dr. Lingeman in Indiana.

Thanks for sharing these statistics.

I do hope FLA gets covered fairly soon.  Not perfect, but it does offer some hope.

Michael

 

Thanks Stan, I take 100,000 sup of the Serrapeptse and it seems to be fine. The product really helped the inflammation I have so bad from years of injuries. I still don’t know of the long term effects of this enzyme product.

Walser has announced on this forum that he is putting a paper out to the Urological Journal out on his results in FLA procedure. I don’t know what Dr. K has coming out on FLA. I still believe the go to guy is Dr. K. if you want this procedure done.

I am told now that private insurance carriers are now picking up a larger part of FLA cost (not medicare). Sure it will get much better as it is and has been for 10 years FDA approved.

Thanks Stan, I take 100,000 sup of the Enzyme and it seems to be fine. The  product really helped the inflammation I have so bad from years of injuries. I still don’t know of the long term effects of this enzyme product.

I am told now that private insurance carriers are now picking up a larger part of FLA cost (not medicare).

Hello Michael, yes I would have to say that things are worse now than pre FLA. I now have partial rero ejaculation, which I definitely did not have before. I still get up 3-4 times per night. 

The Doc thinks it may be related to infection. But I have taken numerous rounds of antibiotics with no change.

The procedure is obviously very expensive and would be totally worth it if it worked. But like I said it didnt work for me or my brother. 

Its hard to decide which if sny procedure to do.

Hi jim- It wasn't an article at all. You just gave your opinion about the FLA and smaller prostates [just based on the 25 or so FLA's that had been done at that time].and how the smaller prostates have seemingly not been as successful as the larger prostates. I didn't confuse you with someone else, as I take note of things that you, in particular, relate in the forums. You are one of the most active post-ers here, and you are also quite knowledgeable, so I always take note of your opinions. Yesterday I did a cursory search for your comment and realized it would take a lot of time to find it. I am correct though, and I'd be willing to have $200 bet on the matter. That would make it worth my while to do the search... haha... lol.

Thanks Vic... that's a very large prostate you had there..! Thanks

Hi Jay, Don't want to take your money but I'm sure you're mixing me up with someone else. What I do remember is disputing those conclusions multiple times because of the scarcity of data. Either that or maybe I had a senior moment and just can't remember But for the record, my stance is that we just don't have enough data on FLA to draw that many conclusions, including the relationship between prostate size and success rates.

So a question, when you said there were five failures, do you include yourself in that five? I think I remember saying that you're not better than before which I think would constitute a failure.

Jim

Stan.... I would like to learn more about your experience with prostatitis and your program with serrapeptase and fasting that you put on another thread. Could you please repeat it here. Thanks, Martin

Often the diagnosis of IC/BPS is delayed in both genders. Men in particular are often misdiagnosed early on as prostatitis, benign prostatic enlargement, or epididymitis and are shuffled through a variety of providers before a diagnosis of IC/BPS is made. Sexual dysfunction is present in as common as 71% of men with IC/BPS (6). Like chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), IC if often associated with similar rates of psychosocial depression (5).

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a common and frequently misdiagnosed disorder in men. Hallmark symptoms are the presence of chronic discomfort attributed to the urinary bladder associated with bladder filling and relieved with bladder emptying, often associated with irritative voiding symptoms, in the absence of any other identifiable cause. It is often grouped with another common clinical entity, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Men with IC/BPS often suffer from a delay in diagnosis and subsequent treatment, often being categorized as having prostatitis, benign prostatic hyperplasia, or epididymitis before the correct diagnosis is reached. The etiology of IC/BPS is poorly understood, and its pathogenesis may involve multiple pathways leading to a common clinical entity. Diagnostic criteria continue to evolve over time as the understanding of IC/BPS improves, and a clinical diagnosis with properly performed history and physical exam is suitable for diagnosis after other processes such as infection, radiation, or pharmaceutical exposure are appropriately excluded. No set pathological findings, biomarkers, or phenotypic descriptions have been universally accepted as a result of conflicting studies. Guidelines for diagnostic and treatment options are limited by available data, and few studies incorporate substantial numbers of male patients. Reported outcomes for common therapies are mixed or have not yet been subjected to study in rigorous placebo-controlled clinical trials in men. Lessons learned from the treatment of CP/CPPS can be applied to IC/BPS, by favoring a phenotypically directed, multimodal approach rather than a stepwise algorithm as advocated by current practice guidelines.

"Stan.... I would like to learn more about your experience with prostatitis and your program with serrapeptase and fasting that you put on another thread. Could you please repeat it here. Thanks, Martin"

Me too. Please elaborate. I have been eating one meal a day inside of one hour now for almost 3 months. The health benefits have been astounding. Stan please tell us more.

Michael, I think all the procedures you mention compare favorably to Rezum in terms or success rates. A better comparision might be Rezum which has as good if not better a success rate than FLA and also has a lower incidence of sexual side effects. The difference with Rezum is that we have more than anecdotal evidence and it's widely covered by insurance. To me it's a no brainer if I had to make the choice between the two. I mean do you want to do essential what is a trial  procedure (and pay for it) or an established procedure with similar or better results? An alternative is to wait a year or two till more FLA data is avaliable because actually no published data is available for FLA for BPH that I'm aware of. Dont let a few anecdotal stories here and a few persuasive members dictate your decision.Just because it worked for them doesn't mean it will for you.

Jim

correction:  First sentence in part should read "..compare favorably to FLA..."

"

I have googled and studied Rezum success rate prior to go with FLA it seems the procedure had 25% retro and ED. It was something I couldn’t take. It seems there are more FLA negative stories than I thought.  But my story was a success at least so far. I did follow dr K advices.  After FLA kept cath for 7 days. Full course of antibiotics for 10 days. Flowmax 2 pulls for the first 10 days and then 1 pull for the next week. No physical activities. No heavy lifting. I didn’t stay on diet as for me this is a pretty normal way of eating. 

I had my FLA done on July 12 about 5 weejs ago and still avoiding physical activities and planning to do so for at least another 3-4 weeks. Better safe than sorry. We are all big boys here and I’m not to convenience anyone to do something but to share my storiy and help someone to make a very difficult decision.  Six week ago I was doing the same reading and studying to make my mind which way to go and I appreciated any one who was willing to share their story either negative or positive. 

Vic: I have googled and studied Rezum success rate prior to go with FLA it seems the procedure had 25% retro and ED. It was something I couldn’t take. It seems there are more FLA negative stories than I thought.  But my story was a success at least so far.

-------------

I was the first here to challenge Rezum's 2.5% stated retro rate but 25% is much too high. I'd say 10% is more accurate which is the same or better than FLA. Also, I haven't seen any reported cases of ED with Rezum, but one fellow here did report difficulty with erections after FLA. Glad it worked out for you but many here still deciding. Personally, I wouldn't do Rezum or FLA for myself, but if I had to choose I'd go with Rezum.

Jim

Vic, I have read these comments and I find some of these to be slanted with out fact. If I had to choose (and I did) I would do the FLA as you did. I think you more than most, understand why. It is something I am please with and I do understand it did not work for everyone. But the few that are on this forum are not at all representative of the numerous people who have had this procedure. Anyone considering this procedure should speak to the doctors who have preformed the  procedure and should beware of comments or advice from someone who has absolutely no practical knowledge even as a patient let alone as a statistician quoting numbers that are based on a small and isolated universe.

It is Simple for those interested, just do the research and at least speak directly with the people who have made decisions before for themselves. Not someone who has no experience but throws out incorrect stats with no real knowledge. Some people really only believe in these case studies which are not done with the intent they try to present as the reason they are done. In other word, life is a racket, beware of all but beware for sure of those who have chosen nothing as a choice for advice.

Vice, pardon me. I forgot to add congratulations on your results. Glad to hear it.

The main thing is that there is not enough data on FLA and I know Dr. K. is suppose to have it ready by the end of the year. Over the last couple of years we have had men that have had good results and we have had some that it did not help but in the steam of things now it is not in most our price range.  We will have to wait and see.  That is all that can be said  Have a great day all  Ken  

here's the latest from Dr.Walser, as posted at Patient forum about a month ago:

"I am publishing latest data on 120 patients with 1-2 year follow up. The manuscript will be in the Journal of Vascular and Interventional Radiology (JVIR). I will also post it here. The bottom line is that properly managed low or intermediate risk prostate cancers treated with FLA have no urinary or sexual side effects and that the need for retreatment is about 15%. I will present these results at multiple medical meetings this and next year. We are following about 300 patients and will continue to publish results as time goes by. I have joined other physicians in the focal laser international network to continue to refine and perfect this technique"

I would venture that FLA for BPH has the same results... i.e. a 85% success rate.  When you have a  competent surgeon like Dr. Karamanian who is well versed in the technicalities of Focal Laser Ablation,  the success rate  depends more on the health of one's prostate. I would venture to say that those patients who have self catheterized for years, been on multiple drugs, have prostatic nodules and cysts, trabeculated bladders, prostatitis and various diseased conditions will have poorer outcomes. I sincerely doubt the size of the prostate of less than 50 grams has anything to do with the success rate. 

Thank you Martin.  We need all the information we can get.  Thanks again  Ken

I would bet that the majority of BPH 'victims' have bacterial prostatitis of some type. From what I have read, when urine tests come back, 9 out of 10 come back negative, even when they are positive. If the patient had the DNA sequencing test for pathogens from the lab in Texas, they could then have more confidence in the outcome of the lab test.

So, to extrapolate, it seems that prostatitis affects the FLA [BPH] surgical outcome of smaller prostates more heavily than larger prostates. It seems that almost ALL of the larger prostates have had a good outcome, but the smaller prostates [<45CC] have not been as good. But so far, this is merely anecdotal, and this is all we have at this moment.

It's also great that a published study will occur soon.

But when Dr. Walser  says "I would venture that FLA for BPH has the same results"... this is a 'venture' that, without statistics, is meaningless. FLA for cancer, and FLA 'only' for BPH are two different things. An FLA for cancer is successful if it ablates ALL of the cancer and the patient remains cancer free, and the FLA for BPH is successful if the patient can urinate freely... two different eggs.

I could not agree with you more. You and Vic both

The research is coming slow.  We know it was good for cancer but we need more research on FLA for BPH only.  It will take time.  And I think we all are willing to wait.  By the end of the year Dr. K. trail will be out.  They need to start another one as soon as possible.  Only time will tell  God bless  Ken

j333....It was I who made the statement I would venture.... not Dr. Walser (note: not in quotes). But Dr. Walser did say this: "The bottom line is that properly managed low or intermediate risk prostate cancers treated with FLA have no urinary or sexual side effects ".

Some cancerous lesions are rather large and a good portion of the prostate is removed. In this particular case, FLA for cancer and FLA for BPH might be considered  having similar characteristics. 

and just to note...patients who have had FLA for prostate cancer often have an improvement in their BPH symptoms...The relationship is there....not necessarily two different eggs.

j3333

Your comment makes me ask what I’ve thought for months: Should men first resolve the prostatitis and only after successfully treatment pursue FLA?

I had a DRE and then sent a post DRE urine sample for next generation DNA sequencing.  It was negative or inconclusive.  

The lab needs prostatic fluid, EPS, to *really* run the test.  

Good luck finding a Uro who will milk your prostate to get a few mL of EPS.  

I tried using the Aneros (?) prostate message device to get EPS.  Tried a dozen times.  Got nothing and felt bad for days afterward. 

I don’t have much ejaculate - thanks to Flomax and BPH - but I think semen would have a better likelihood of containing bacteria than would urine.  No?

Thing is, if infection is found (in my case, I would have the biopsy to thank), how does one treat?

Eight weeks of fluoroquinolines?

That could devastate tendons and gut flora.  

Antibiotics injected into the prostate?

Must be extremely painful and won’t that make a big prostate even bigger?

When I talked to Dr K in March, he had injected only two patients.  I’d want someone who’s done that procedure at least 100 times, tbh. 

If a man has FLA but doesn’t treat the accompanying infection, is there going to be any improvement in his misery index?

Thanks

Michael 

Martin

I had one Uro tell me that BPH and PCa are two different disease progressions, and that, generally, a man will have one or the other but not both.  

Would the double whammy of cancer and BPH be pretty rare - to have apples and oranges at the same time?

Thanks

Michael 

Michael speaking from first hand experience you are correct. If you can not get rid of the prostatitis prior to the FLA it is a waste of time and money. The hope in my case was that the ablation itself would at least in part destroy the bacteria. That was not the case. I am worse off almost a year post FLA than I was before.

As far as you test goes. I have been successful by using the Aeros, then getting a seven sample immediately afterwards. I think that way you at least get some prostatic fluid.

Michael

You might look at this link https://link.springer.com/chapter/10.1007/978-1-60327-126-4_15 and consider the Stanford protocol for chronic prostatitis. I have been working with Dr. Sperling in Florida and he has a physical therapist seeing patients with chronic prostatitis and using this technique. Not sure of how well it works yet and we don't provide it where I am but it seems to show some promise.

As far as FLA for BPH, I am pooling my data with Dr. Sperling and will submit this for publication later this year. Initial results look good. My only question is how long does the effect last? Needs to be effective for at least 5 years to rival results from TURP.  

 

Thanks Joe. 

I think I’ll try again with the Aneros, then collect semen and send to lab. 

If it’s positive I’ll look at antibiotics.  I take Vitamin D3 and oil of oregano to boost immune system.  Maybe that will knock it out.  

If negative, then I can consider PAE.  

Realistically, I have to wait for insurance to cover FLA given careful analysis of family financial situation and discussions with my wife who is deadset against FLA.   

My PSA hasn’t been the same since my biopsy and my QoL has suffered.  

Thanks

Michael 

I just read this entire thread from the beginning. 

Just curious.

You mentioned, "I still believe the go to guy is Dr. K. if you want this procedure done."

I am curious why you believe Dr. K is the go to guy if Dr. Walser performed your successful FLA procedure? Thanks

I will send you a personal message shortly. Don't want to get moderated yet again. 

Micheal,

Google DR. Duke Bahn In california. 

Cj

j3333: But when Dr. Walser  says "I would venture that FLA for BPH has the same results"... this is a 'venture' that, without statistics, is meaningless. FLA for cancer, and FLA 'only' for BPH are two different things. An FLA for cancer is successful if it ablates ALL of the cancer and the patient remains cancer free, and the FLA for BPH is successful if the patient can urinate freely... two different eggs.

----------------

Agree.

Jim

Jim,

Is there no data that tracks FLA results and is published in journals?  With the number of patients who've undergone the procedure (Dr. Sperling alone must have > 1000), what is holding this back?

One can find compare PAE vs. TURP (see: https://www.bmj.com/content/361/bmj.k2338).

 

Jim,

(cont. from above)

Even if the "success" rate for FLA is 70%, would that not compare favorably to more invasive procedures such as TURP?  Success can be quantifiable: compare IPSS, QoL index, void rate, PVR, prostate volume, PSA pre-procedure vs. post-procedure, and then plot FLA results vs. the so-called gold standard of TURP, as well as HoLEP (there must be a lot of published data on HoLEP, or am I simply too naïve?) and PAE.

From my research, FLA seems most promising of the available options for BPH, and it has found a home in treating localized cancer.  FLA and PAE "appear to" present less risk for loss of sexual function (RE and ED) and incontinence than, say, TURP.  I suppose the quotation marks can be removed w.r.t. PAE but do we know if that's the case w.r.t. FLA?

Personally, I'm confident in FLA from all I've read.  The $$ issue is holding me back.  But, of course, I'd feel better if there were published studies in the journals with a large sample size.  I think it will come to that - and maybe when it does, the insurance companies will get on board.

When I think of my father's generation, TURP was the only option.  So, we've come a long way with more progress to go.

Thanks Jim.

Michael

Hi Michael,

No published data that I'm aware of for FLA for BPH, just anecdotal accounts.

Jim

Michael: Even if the "success" rate for FLA is 70%, would that not compare favorably to more invasive procedures such as TURP?

---------------

First, the 70% is anecdotal versus published data. But assuming the success rate is 70% it's really no better or worse than any of the other procedures. FLA also promises less sex side effects which is a plus over the more invasive procedures like TURP, however retro from FLA seems to run about the same as Rezum, so personally, if I had to choose today between FLA and Rezum, I would choose Rezum. Success rates and retro about the same but Rezum has study and durability data behind it plus your insurance should pay for Rezum but probably not for FLA. Down the road, FLA might be a better decision, but I'd like to see some published data in peer reviewed trials.

Jim

Thanks Jim,

What I like about FLA (over Rezum and others) is it is not intra-urethral.  What I like about Rezum and many others is insurance picks it up. 

Hoping (and expecting) FLA will be covered once there are published trials.  Of course, if less expensive treatments are available for the same diagnostic code, where's the benefit to the insurance companies to cover the more costly procedure?  It all comes down to $$.

Michael

Good afternoon.  I hate to change the subject.  Has anyone hear or seen Frank on the site.  Have not seen him on for at least 6 weeks.  Any information will help.  Thank you  Ken

Ken, I've wondered about Frank myself. The last I heard from him, must be weeks ago, he was having to self cath 10 to 12 times a day, thinking about having Rezum. Maybe he got better and quit this forum. Hank

Hey Hank.  I sent him a few PM messages and the last 2 have not been read.  About 6 weeks ago.  I hope he is ok.  He is by himself since his wife died.  I talk to him once a week but nothing now. Don't know if he got better or not.  Ken 

Just to clarify--"I would venture that FLA for BPH has the same results" was not my statement. I believe that it is true although a decrease in ejaculate volume is expected. 

Eric  I put some information about that on one of the site.  I will write it again here.  I ask him a guestion about the connection between the seminal vessel and the ejaculatory ducts.  This is what he said .  With FLA I expect the connection between the seminal vesicles and the ejaculatory ducts to remain intact.  With the information I have gathered most men that I have treated following FLA may have a small but not a tremendous difference in there semen volume.  Most you lose is about 15 % That is because the prostate is smaller.  Hope this helps.  Ken 

There is usually not a noticeable loss in ejaculate volume after fla for

Cancer. However, the loss of Prostate tissue after fla for bph is more extensive and causes a loss in seminal fluid production ( most fluid produced in prostate— not testicles). The use of alpha stimulation (sudafed, etc) 1 hour before sex may help but I am not convinced. Even avoiding ablation of the ejaculatory ducts (which have a typical location but may not be visible by MRI) will not affect this drop in volume. 

Hi Joe,

I am wondering if I missed something somewhere about prostate FLA failure with prostatitis.

Has there been some added data or are we still trying to figure out why the smaller prostate procedures have been less successful? Does anybody know?

I’ve got a 30cc one witty BPH and am considering FLA above the other procedures.

 

I am trying to give the information FLA for BPH Most of the fluid does not come from the prostate you get 30 % of fluid.  The seminal vessel give you 70 %.  With FLA they save the connection of the seminal vessel to the ejaculatory ducts   With any procedure they will take out half of the prostate So you get 15 % from the prostate that is left and 70 % from the seminal vessel So your ejaculate 85 %.  Which I think is great.  Now if you look at Aquablation the procedure you end up with 15 % because the jet makes the tunnel and they do not save the Seminal Vessel You will end up with very little.  Take care  Ken

The prostate manufactures most of the seminal fluid. Spermatozoa from testes is minimal. Thus, ejaculation is compromised with loss of prostate tissue. The ejaculatory ducts and seminal vesicles do not matter if prostate is debulked significantly.  You can’t get the juice without the squeeze.!

Regards 

Eric,

Where did you get the information that "There is usually not a noticeable loss in ejaculate volume after FLA for Cancer" ?  If true it would support the theory that the loss of ejaculate volume is proportional to volume of prostate tissue ablated.

Thomas

Experience  

Good morning Sir. No added data, other than anecdotal. In addition to the guys who have had FLA failure with small prostate, several of us also had prostatitis issues. FLA does not appear to be effective with those of us with the two conditions.

 

I have to agree with you Eric. My. Ejaculate volume is significantly less after FLA. It is almost like a retro ejaculation. 

 

I had FLA in April of 2017.  My ejaculate was the same or more after the procedure.  As of today, it is the same or more.   I had zero side effects from the procedure.   Unfortunately, the efficacy of the procedure has greatly diminished and I am back on alfluzosin (taken every other day).  My prostate size before the procedure was 45 grams.

Two years ago, my ejaculation fluid  was more right after the procedure. Then it seemed to decrease and dwindled some and seemed to be less. But now it is back to normal as before the FLA. This all happened within the first 8 months. I feel it was part of the recovery.

So far, so good. 

Thanks Joe,

I might be in that camp too. I just started a course of antibiotics for Enterococcus facailis. I’ll see my Uro next week re this new development.

Has Dr k. Had anything to add re the prostatitis and small prostate?

and what are the new symptoms of the failures?

 

Thanks for sharing Trust. It's good that you have no side effects from FLA. But your situation of diminished efficacy raised aother red flag on longevity of FLA, as jimjames questioned at the height of FLA popularity. Bummer! I hate to admit that sardines are actually good for you. 😀 Hank

Eric where did you read that.  Your prostate only make up 30% of your volume.  The seminal vesicles makes up 70 %  I have the paper work at home.  In GA for 6 day.  Being that they take at least half of the prostate with most of the procedures that leave you with 15 % only is that would be 85 % so you will not lose that much. That is from FLA  Every man is different.  Some men make more then others.  So with Aquablation  They do not vary the whole prostate is hallow out from the bladder neck to the ejaculatory ducts so you are only left with 15 % volume  They end up with very little..Ken     

Joe the way Dr. K explained it to me is he tried to avoid the seminal canal and the ejaculatory duct when he does the mapping. It is not all ways guaranteed.  If he does they you will have 85 % of your volume.  If seminal vesicle are not connected you will only have 15 % from what is left of your prostate.  Have a good day  Ken       

But your situation of diminished efficacy raised aother red flag on longevity of FLA,

-----------------

There were some non invasive procedures a while back, TUIP and Microwave comes to mind, that had initial promise but soon fizzled when symptons returned. Not saying that's the case with FLA, but we really just don't know because so little data. Hank, sounds like you're almost ready to partake. Sardines and scrambled eggs make a fine breakfast with a side salad.

Jim

Wonder how sardines go with raw garlic. I have been eating raw garlic to combat symptoms of asymptomatic UTI, which is a side effect of long-term CIC , as you already know. But now suddenly garlic doesn't taste so bad. Hank

Hank, unclear if you're symptomatic or asymptomatic from your post?

An asymptomatic UTI, or more accurately, asymptomatic bacturia, by definition has no symptons, just that more than a normal count of bacteria is detected but bacteria as you know isn't necessarily bad. Asymptomaic bacteria is more accurate than asymptomatic UTI because there is no infection. Garlic should go fine with sardines, give it a go.

Jim

I did some more research and you guys are correct. See below.

Semen volume about a teaspoon normally

testes 2–5% Approximately 200-500 million spermatozoa (also called sperm or spermatozoans), produced in the testes, are released per ejaculation

Prostate 25-30%

seminal vesicles 65–75% 

bulbourethral glands < 1% Galactose, mucus (serve to increase the mobility of sperm cells in the vagina and cervix by creating a less viscous channel for the sperm cells to swim through, and preventing their diffusion out of the semen. Contributes to the cohesive jelly-like texture of semen), pre-ejaculate, sialic acid.

I suspect that the drop in volume represents either loss of prostate portion (extensive ablations) which is likely not reversible versus ejaculatory duct compression/injury which may go away with time and healing. 

Yes It's not problem  We are all on here to help each other Have a good day  KEN

Jim, definitely asymtomatic. One doesn't have to be a sardines scientist to know the difference. 😀

It's not doing anything to me other than cloudy urine, high count of bacteria, high alkalinity, and what I don't like most : struvite crystals. Struvite crystals are small bladder stones that can become troublesome.

I am just cautious and like to experiment. So far, raw garlic is doing a good job reducing all of the above. Hank

Hank,   Raw garlic seems to improve my urinary symptoms also, and my sinuses also.  I crush it in a garlic crusher and put it on toast with olive oil.  The crushing is necessary to activate the allicin in the garlic. Within 10 minutes of eating it I usually have to go.

Thomas

Thomas, raw garlic also lowers blood pressure. Hank

I am fairly disappointed myself in the overall results. My volume was GREAT immediately after the procedure. And the initial results seemed to be good for the BPH. But in the 3 month time frame afterward my stream dwindled as well as my ejaculate volume is almost none.

Joe

Hi Joe,

so disappointing to hear about your resuts... since you didn't mention it in this post ..

what procedure did you have ?  I scheduled to have the Rezum procedure in Oct.....yikes !!

Hey Robbie, I have had PAE, and FLA. 

Hi Joe,

So you've had both and neither worked ?? 

Yes sir unfortunately I sure have. And neitherworked.

Ever consider a Green light/PVP procedure?  Sounds MUCH less invasive and more successful than the PAE... jeeze!! 

I am scheduled for a PVP later this month... am a bit concerned with some of the feedback on problems afterward, but know that most will post reviews only if having problems, so hopefully most do great with it.  Just started CIC, far less uncomfortable than I expected... so that is a option I guess...

My friend.  The feedback on here is suppose to help you decide on a procedure.  Make sure you have been told all the side effect and voice your concerns.  not everyone on here have had a problem.  There are good outcomes in all procedure.  The ones that have a problem are just letting you know what can happens.  CIC is good that can buy you some time if you want to wait  Good luck  Ken

Thanks, I agree... and most guys are more likely to post reviews if there was a problem, not so much if all went well... I am leaning towards HoLEP, but just turned 62 and might have to CIC for three years until Medicare kicks in... seems a long time... I am seeing another Urologist that does the HoLEP, so will see... will ask him about all the other options too... maybe just a BNI... any idea/feedback  on that procedure alone?

John. I am at the 8 month point and have noticed that my urine flow seems to be gradually decreasing and having some residual urine in the bladder. I may give Dr K a call sometime to discuss it with him.

Hope you are doing well.

Richard,

that is about when things started to go downhill for me. You should call Dr K. I spoke with him several times to get some ideas on what to do.

I met with several italian scientists

( Drs Giovanni Mauri and Gianluigi Patelli) at the Congress of the Interventional Radiology Society in Europe (CIRSE). Their new laser was approved by FDA recently and US centers should open soon. The procedure is transperineal but uses small (21g) needles. Only local anesthesia and an outpatient procedure.

They published a small series of patients with good results.

About 70 patients. The mean prostate volume changed from 74 ml to 49 ml; mean post voiding volume from 151 to 30ml; mean IPSS score from 22,3 to 7,7 ; mean Qol score from 4,4 to 0,8.

The follow up range was 3-39 months (mean 14 months).

No major complications occurred.

Stay tuned.

Eric,

I'm assuming you are referring to an upgraded FLA procedure? If so, can you please advise what "soon" might be? Any idea about FDA and/or Medicare approval? Do you know if it is being done in Europe? Any idea of cost? Clinical trials?

Thanks for any information.

Fred

If you google or use pubmed, look for the article they wrote in a journal recently by using authors names and BPH as keywords. I don't have it with me but should not be hard to find.

The company is Elasta and it is being done in Europe. No sites in US yet but the first cases would likely be part of a trial and free to patients.

No insurance company nor Medicare will pay for this yet.

Thank you. Can you please let us know if you get updates on this? Sounds like a great option.

Below is a more detailed of the new procedure that Eric mentioned. It's definitely not FLA

" Introduction & Objective : Over the last decade, there has been effort to identify new technologies aimed at a minimally invasive and rapid therapy for patient affected by symptomatic Benign Prostatic Hyperplasia. The aim of the authors is to evaluate the safety and efficacy of the ultrasound guided Transperineal Laser Ablation (TPLA) in the treatment of Benign Prostatic Hyperplasia (BPH).

Methods :

67 patients (age 73.1 ± 10.7 years, range 51-93) suffering from obstructive syndrome secondary to BPH, (28/67 patients urinary catheter carrier), were treated with TPLA using continuous wave (CW) diode laser source operating at 1064 nm wavelength. By ultrasound guided transperineal approach, depending on the glandular volume, up to two fibres through 21 G needles for each lobe, were inserted in the prostate. Each treatment were performed with a standard protocol (3W power with maximum 1,800J delivery for each fibre illumination and eventually pull back) according to the prostate volume. The efficacy of the treatment was evaluated considering the changes of International prostate Symptoms Score (IPSS), the Quality of Life score (QoL), Post-Void Residual (PVR) urine, peak urinary flow rate (Qmax) and prostatic volume. The mean hospital stay and mean catheterization time were measured.

Results :

All 67 patients were treated without procedural complications. The mean operation time was 40.3 ± 7.4 minutes, mean ablation time 15,9 ± 3.9 minutes, mean energy deployed 10,746.3 ± 4,033.3 J, mean hospital time 1.5 ± 0.4 days, mean catheterization time after the procedure was 24.2 ± 14.6 days. Mean follow up was 14 months (range 3-39 months). IPSS improved from 22.3 to 7.7 (P < 0.001), QoL from 4.4 to 0.8 (p < 0.001), Qmax from 9.2 to 12.1 ml/sec (p = 0.001), PVR from 151.7 to 30.2 ml (p < 0,001), prostatic volume from 74.7 to 49.5 ml (p < 0,001). No major complications occurred

Conclusions : TPLA is a novel option to treat patients affected by BPH. This approach was efficacious and safe with significant and durable results. "

Hank

Hank,

Thank you for the information. Quite interesting. If you find more on this, please let us know.

Best wishes,

Fred

The folks in Italy introduced me to laser ablation of liver lesions around 2000

The interesting aspect of their approach is very small fibers and needles used for a transperineal ablation. This procedure is for BPH not cancer

This is FLA, except they go through the perineum (the area below the scrotum) instead of through the rectum. All of their patients stayed in the hospital for at least a day. Fundamentally, this approach works. I think using MRI instead of ultrasound guidance is better, and I think the transrectal approach (which done properly) is better.

Good afternoon

I tried to find some information on this procedure and there is not much. All I could find is the same on 3 sites. It does not give you any information on sexual function or you ejaculation function.

All it said was that all procedures were technically successful. No complication???

That can mean a lot. Going through the perineum may be better then going through the urethra. But it tells you nothing about avoiding the nerve bundle's, ejaculatory duct's or the seminal vessel.

Even if they are using a MRI. They should at least tell you we will be avoiding all the good stuff to save your sexual functions. Maybe they will explain it once it start being done more

My friend when you had your FLA procedure or do you know with a MRI are you able to see the nerve bundle on the prostate they are very small and there are a lot of them. With this procedure can they damage them my mistake

If we decide to have this done we should know everything what can happen and any side effects.

Have a great dayKen

Richard, yes, Thank you I am doing well. I am most concerned about the residual urine comment. Please call Dr. K as soon as you can and discuss. He is in procedures usually on Tuesdays and Thursdays.

Your flow changing is probably a result of the reduction and reforming of the prostate as tissue has been removed. It has been two years for me and I noticed changes for about 11 months. All is well now for me and I am pleased. Sorry it took me a while to respond to you as I don't see these post daily any longer. But, willing to respond and help if needed. Good luck.

Oh yea, I forgot to mention. I started using Serrapeptase, the enzyme that has been written about on this site and it really help me in a lot of inflammation all over my body. I was amazed. I don't know if you have any inflammation while healing but this is worth looking into. My recovery time on Golf went to zero. Wish I would have known about this when I was recovering from the FLA as I know it would have helped my inflammation then during the healing.

Hi Hank... in the above... "Qmax from 9.2 to 12.1 ml/sec" If this is the stat for improvement I can guarantee that this improvement would barely be noticeable. I have done peak flow tests probably 6-7 times... 3 mils/second as a peak flow improvement is not enough. Are you sure about this stat...? Cheers

Thanks, John. Yes, I agree.

j, I agree that 3mL increase in urine flow is hardly noticeable. But I checked several sources and they all are the same. Hank

ken

Ken, sorry I just now saw your post.

Yes, I would tend to agree with your concern. FLA is much more accurate when the doctor is using an MRI machine. This is one of the reasons that Dr. K’s procedures take so long. He checks the machine and measures everything and then he places the laser and he checks it all again. He recalculates the area of tissue to remove and the path and then before he removes any tissue he does it again. Lots of men have reported that he takes about 3 hours on the procedure and this is unique to him because he is very careful. Much more so than another Interventional Radiologist.

In answer to your question YES you can see the sexual components of the gland on the MRI if a 3T MRI is used. Dr. K showed me mine before and after the FLA procedure when I met with him.

Dr. K has done over 120 FLA procedures now. He is averaging 4 procedures a week now. A lot of them are for Cancer and BPH at the same time. He has really gotten good at this over the two years.

I believe you should call him with all your question both on this procedure and on the procedure that Hank and Eric were discussing. He will tell you the differences in the two. Interventional radiologist do them both as it is a focused ablation. I would bet the other one is not as expensive as they use ultra sound instead of that $3.5 million dollar Siemens Skyra 3T MRI machine. I just don’t know of anyone doing it in the USA.

If you have your MRI send it to Dr. K and he can talk to you over the phone and show you those parts you want to know if he can see. He does not charge you but it could take a while to get the conversation going as he has procedures now that take up his time. But he does not charge you and he will tell you the real truth about it all. I know Monday and usually Fridays are good days to talk to him and Donnie.

Hey there John

It's no problem I know your a busy man. I knew you would get to me when you can

I find this procedure interesting but you can't find any information but the basic stuff

I know that the procedure is done through the back side. Don't know if that is good or bad. It also tells you that they will insert up to 4 21 G applicators into the prostatic tissue. It is done with diode laser

They talk about all the technical stuff but tell you nothing about personal things that all men like to know. It says nothing about the nerve bundle or seminal vessel. Going in the back your not in the urethra and not touching the ejaculatory ducts so you may be ok there but you never know.

I would like to know ( You know me I like to be ready for anything ) when they turn on the laser does the beam or energy stay in that area or does it spread. If it spreads it could damage something

Yes I think I will get a hold of Dr. K I do have his number and his e-mail.

You said he is doing a lot of cancer and with BPH procedure. Does that been that the procedure is being covered by insurance. I know FLA is approved for cancer treatment

Will thank you for getting a hold of me and have a great day

Best Wishes.....................Ken

Ken, the procedure you are researching is not done through the rectum It is done by inserting the guide needle under the scrotum while laying on your back this area is called the perineum (the area below the scrotum) instead of through the rectum. I personally would prefer the rectal approach as with the MRI guided Focal laser Ablation That Dr. K does. During my FLA I never felt anything in my rectum or in my prostate. But, again I understand that you stay one night in the hospital with this ultrasound perineum procedure you are researching. I left the FLA procedure and went to a restaurant to eat and then to my hotel. I did not stay for even the after noon. I did have a catheter attached to my leg but not a big deal for me. You would have that with either of these approaches.

And, again, another concern to me is that you do not have the vision into the gland during this procedure that the FLA with MRI has because they use an ultrasound instead of a MRI.

The beam of energy you ask about is fully controlled if the doctor knows what he is doing. I am aware of a ablation of a cancer tumor that was done on an artery going into a mans heart and the tumor was removed without damage to the artery. The control of the energy is down to 1mm of accuracy in a lot of procedures. Interventional Radiologist preform Ablation work on most organs in the body. They specialize in different areas. My Dad had a Cardio Interventional Radiologist for the Ablation done in his heart for Afib. The Cardiologist was there during the procedure but the Radiologist did the heart Ablation. So YES the energy beam is very controllable and very accurate in the hands of the radiologist who is trained, specialized, and dedicated to the specific treatment . We who have these Prostate issues are lucky that at least a few of the Interventional Radiologist chose to specialize in the treatment of the Prostate. The Urologist don't like it but we all know why.

Last, insurances especially private is getting better on FLA both Cancer and BPH treatments are FDA approved and the insurance codes exist. Medicare is more difficult. It is a matter of time and pressure. The urology associations work hard to lobby and keep the insurance not paying for prostate procedures they can't provide and make money on. Insurance pays no more for cancer than they do for BPH. It is not a matter of what it is done for it is political between urology and radiology. Both are FDA approved. It is just hard for a few specialized IR doctors to put the pressure on the insurance companies when urology is fighting it and their groups are much bigger and more powerful. It does not have to do with what is best for the client.

You should call Dr. K and Donnie and ask all these and more questions. Friday would be a good day to call. Good luck my friend.

Stay in touch, the game is on so I have to go watch, GO SOX. My ex partner of a company I had in the early 90's is a pitcher for the Red Sox. He is 6'5" and 235. I was at his birth and watched him grow up. His name is Brandon Workman. I hope he pitches late relief tonight. I would love it. He is now 30 years old and will have two world series rings if they win this series.

John

Thank you for telling me about the procedure. After I sent you the information that is when I remembered the way the procedure was done they were talking about it was done like a biopsy. I have to start re reading what I type

Not into baseball now but my son may know who he is I will tell him when I pick him up from work at 2 AM. When I lived in Detroit I use to go to the Tiger's games. Love the double hitters I hope he wins tonight

Have a good day and evening.....................Ken

Cheers Hank...

Hey all

We are doing some exciting research with our European colleagues and the FDA using new laser fibers with longer diffusing tips and newer approaches through the perineum and rectum and even WITHOUT needles. The common denominator is that ALL procedures are done with MRI thermometry sequences, which, as J12080 references, are precise and effective in prostate tissue destruction without side effects. Newer and better ways to monitor tissue destruction by MRI are being developed and can be used on 3T MRI machines as a software upgrade so that prostate cancer and BPH treatments can soon be provided as a "mobile" service so that interventional radiologists can come to the patient's location rather than them traveling to us.

As more clinical trials evolve, interventional radiologists can use a variety of mechanisms to treat both BPH and prostate cancer effectively and safely. Some of these are very new and patients need to think carefully before agreeing to be a part of a trial which may be investigational but offered at zero or no cost. Rezum and Urolift are also modern procedures for BPH and deserve investigation by doctors and patients both.

CMS (medicare) reimbursement for procedures like FLA may be near but looks like they may be initially limited to high-volume academic centers in local areas. This will likely be announced first quarter of 2019.

As you survey areas/hospitals providing FLA for cancer or BPH, make sure that they have adequate experience, have certificates of added qualifications in interventional radiology (Dr. K's is pending), and have the means to treat you should post procedure complications arise.

Regards E

E,

Are the procedures you are talking about FLA or similar to FLA ? Where can we find out more about them and possible clinical trials ? Also how can we stay posted about possible Medicare or insurance coverage ?

Thomas

Thomas

New laser companies are Elasta (Italian) and CLS (Sweden). Their products are FDA approved in the US but not widely available yet.

I was finally able to create a You tube link for MRI urodynamics in a normal volunteer.

It is at

https://youtu.be/DgnJoK8xle0

We are working on this as a way to investigate bladder dysfunction and BPH at the same time as MRI for prostate cancer. As you all know, some men with small prostates have bad urinary retention symptoms and some men with huge prostates have no symptoms.

We think the urodynamic data will add to the information from the MRI at no additional cost. The bright urine is the natural MRI appearance of fluid so no additional contrast or catheterization is needed. When we are ready, the patient urinates into a condom catheter connected to a bag and a video MRI sequence captures the details. We believe that we can calculate post void residual, maximum urinary velocity and maybe even evaluate the muscular contraction of the bladder in normal and diseased states. Work in progress.

As some newer laser products are made specifically for BPH and cost less than those made to eradicate cancer, the ability to monitor urinary function at each follow up MRI study is helpful. It may allow radiologists also to compare the effects of competing therapies, including Rezum, urolift, transurethral proceures, steam vaporization, etc.