Going with Focal Laser Ablation for BPH
Posted , 73 users are following.
Ok, I have decided, I am going in the next 21 days for FLA. I have picked dr. k if the schedule of my wife's treatments can allow it along with his schedule. He is busy with some complicated PCa cases as well as talking about a partially self funded clinical trail scenario for BPH patients.
If I cannot line up with him, his associate is Walser and I will get him as they still work together at the same hospital. Maybe I can get both involved and get a double bang for my buck. I will let you know soon.
3 likes, 1293 replies
anthony2858 j12080
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J12080,
I have been considering the FLA as well, and with Dr. K as well. I have just not been seeing enough reports on the procedure to finally move forward. The other option was the PAE procedure with a doc in Florida, but just feel like I am further along with my BPH than what a PAE may accomplish. Talked with D. K for about an hour and he seems to feel that it is the best procedure out there for BPH.
Anxious to hear of your progress reports. I had mentioned to him that if I do it that If i need to have a cath in for multiple days that I want on "with out" the bag, only a valve so I can go pee when "I" want to,just like with doing CIC, Just go to the bathroom and open the valve. No need for the bag.
Anyways, good luck with FLA! Hope all works out fine for you.
Have a great weekend Anthony.
Motoman anthony2858
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Anthony,
I think you should take the bag, as well as a valve. I just did what you were proposing with the valve. It is a strange feeling in the Bladder when it empties with a cath in. I didn't like it, so used the valve in the AM until I couldn't take the feeling any longer. Then I used the leg bag until evening when I used the night bag.
I hated the Foley, had it in for one week.
MikeSkier j12080
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How are you doing today? My pre-procedure MRI is next Monday and I am hoping for April 5th for the procedure in Houston.
You have been holding out on me, Jim told me that there have been at least 2 other FLA/BPH patients besides you, Motoman and Mike588. He even thinks there maybe at least one more. I am sure that he is going to be starting his test soon, so far no one that has been done is included. I hope that we can get everyone out on this forum to not only monitor their progress, but to promote the procedure and no one has promoted it more than you.
Thanks - John
Mike
jim81578 j12080
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Just had my 3t mri done about 3 weeks ago and according to UCLA in Valencia, Ca. I have no lesions. Spoke with Dr. Karamanian about the findings and what was kinda strange was at first he said they had miss read and I had 4 lesions and i should get a biopsy done. I sent him the paper report so he could call ucla to talk with the person who read the finding of course that person was not in. After all that he called me back and said he changed his mind and there are no lesions. I will be seeking a third opinion any recommendations? He had also sent me a few pics and pointed out areas he thought there were lesions. After that I spoke with him a good hour or so on bph. He told me the procedure takes about 2 hours. They do give you some pain and some sedation during the procedure. Typically there isn't to much pain (yeah right). He recommended I stay in Houston for about 3 days after fla. He also told me that I would have a catheter in for a week. Told me that he has done about 50 ablations i'm not sure if that's a combination of bph and removal of lesions. He also said there is no guarantee it will work. He did tell me that usually there is always some sort of relief on bph. The cost for fla is $20,000.00. I am more than likely going to go for it after i get a 3rd opinion. He did say that I do have areas on my prostate that are restricting urine flow as well as the UCLA report said. Over all I guess this is good news as of right now I have no cancer that can be seen. I am hoping others may come forward that have had this procedure done and tell their story. Dr K seems to be very informative and is willing to give you as much time as you need to discuss any concerns you may have. Just hate the part that there is no guarantees. I guess it's just a crap shoot. Sometimes you win and sometimes you don't. I have blown lots of money in my time, but never $20,000. at once. $20,000.00 is a lot of money to me and will take a big chunk out of my savings. At the moment I just need some inspiration. Fla seems to be in my opinion the best and easiest procedure for bph. I also would like to thank all the people in this group for all their personal stories and advice as I've truly learned a lot about prostate problems and what people go through.
jimjames jim81578
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Check with John Hopkins or other major centers to see if they have a second opinion service for 3T MRi's.
As to your bph, what exactly are you symptons and what tests other than the MRI have been done. Have you had a bladder/kidney scan? Do you know your PVR (post void residual)? Urodynamic studies? Do you know your IPSS score (if not, google "ipss score" and take the 5 minute online test"
. The fact that your MRI showed you have some areas "restricting urine flow" is not enough in and of itself to warrant anything.
I would also ask Dr. K. how many of those 50 ablations were specifically for bph as opposed to for prostate cancer.
Jim
jimjames
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jimjames
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Peter02 jim81578
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Jim, I've also spoken with Dr K who was v helpful, also Dr Spirling who is not as conversational & more expensive, but was told he has done aprox 1000 FLA although of course not so many for BPH as this is a new use for it.
Recently spoke to a radiologist who pointed out they were doing MRI guided tests with HIFU (in the UK). Is FLA also known as 'Blue Laser' or under any other name?
kenneth1955 Peter02
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jimjames Peter02
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Hi Peter,
I think it's promising that MRI guidance is starting to be incorporated into various procedures so treatment can be more focal and less roto rooter.
Not sure if "Blue Laser" is the same as what Dr. K. uses, but maybe someone more familiar with Dr. K. knows the laser he uses. BTW what exactly is "Blue Laser", could not find a reference with a quick search.
Jim
uncklefester Peter02
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Dr.Dan uncklefester
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Hi everyone,
I was surprised and happy to find this thread regarding FLA as an intervention for BPH. A couple of years ago I administered my first FLA solely for BPH after many of my prostate cancer patients consistently reported that their pre-existing BPH symptoms had abated or completely disappeared after their PCa ablation. It made sense to me that the reduction in prostate volume due to the resorption (reabsorption) of the ablation defect (scar tissue) had alleviated the benign volume increase that can accompany aging. Published literature (e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185301/
tells how prostate cryo had this affect) and dialogues with international colleagues suggested that strategically applying FLA would benefit BPH patients. Indeed, this has been the case, and I’m happy that the concept is gaining a wider audience.
A quick note to unclefester who posted that he was unsuccessful in getting through to our center. I hope that situation was soon rectified. We just completed installation of a new magnet at our new permanent location, and opened the Sperling Medical Group in addition to the Sperling Prostate Center. Despite our best efforts to avoid communication gaps, I sincerely apologize if your attempts coincided with that transition, as we learned after the fact that a gap had occurred. Please give us the benefit of the doubt, and try again at 561-300-1363.
I am grateful to each of you for sharing your experience, which helps all of us docs better understand the patient’s world.
Sincerely,Dr. Dan Sperling
Please note: This post is intended as participation from the physician viewpoint, not as an attempt to create a physician-patient relationship.
kenneth1955 Dr.Dan
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jimjames Dr.Dan
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Hello Dr. Sperling,
Thank you for taking the time to participate here on the forum. And thank you for pioneering FLA for BPH, which from all accounts sounds like a promising, less invasive, more precise and intelligent alternative to the so called "gold standard" TURP and similar.
Many of us here with prostatic obstruction also have compromised bladders resulting in chronic and even acute retention. Some in this group have had failed procedures to one degree or another. Some are still in watch n' wait mode. Some are on meds and some are self cathing (CIC).
Some newer literature suggests that many in this sub group (compromised bladders) may not benefit as much from prostate reduction surgery (FLA or otherwise) since their lower urinary tract symptons (LUTS) is as much (or more) bladder related as prostate related.
What are thoughts on this and what screening tests or procedures do you use to make sure that the prostates you ablate have viable enough bladders behind him to produce good results.
Jim
kenneth1955 jimjames
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Dr.Dan kenneth1955
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Hi Ken,
You asked about the FDA approving FLA for BPH. The FDA has cleared FLA for soft tissue ablation without specifying the organ or the disease condition. I think what you are asking has to do with payments and reimbursement, and FDA clearance is separate from Medicare. Until Medicare makes a National Coverage Determination (NCD), which can take years to accomplish while they review scientific and clinical data, it won't cover payment (all or a portion). While private insurance companies can still make their own determination, they usually wait for Medicare to get on board with coverage. The short answer is, not even a psychic can say when Medicare might make an NCD FLA for BPH..See Medicare's revised procedures at https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/FR08072013.pdf
Sincerely, Dr. Dan
Please note: This post is intended as participation from the physician viewpoint, not as an attempt to create a physician-patient relationship.
kenneth1955 Dr.Dan
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Thank you Dr. Dan for the answer to my question. I hope it will be soon because it will help alot of men. With alot of the surgery that they have for BPH. I don't care if going to the bathroom is the goal I do not what the effects that 9 out of 10 of the surgery most of all retro ejaculation Im 61 and I don't feel that t is right to ask a man to give him his ejaculation just because we don't need it because we are older and not having kids. It is a function of your orgasm they go together. Thanks again for being on this site with us. Any help from you will be worth alot to us Ken
j12080 Peter02
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Peter, I just have gotten caught up on reading the thread. In answer to your question on Blue Laser. I researched this back last year in an effort to make sure that I was going to use the best solution in my procedure. I did this even before I selected a Doctor. I spoke with Medtronic in serarch of the Blue Light Laser. They told me that was a marketing name used by a Doctor in Florida and the only thing that was blue light was the switch on the Visualase laser equipment to procedure. They said it was not their marketing name. The Viusalase unit is the one that is used by every one currently. There is a new one coming on the market out of Sweden but it is not fully approved at the time I was researching and had only been used by a Doctor to practice on a slab of roast beef at that time. (Not kidding).
I saw your quote about that Doctor doing 1000 FLA procedures and my mind immediately multiplied 1000 times $20,000. Wow now that is a good business career. $20,000,000. Don't know the expense line, and can only speculate on profits, but seems like the price could come down now and not go up? Oh well, I got my moneys worth and would have paid double if I would have known the results before hand. It was well worth it and the credit cards will be paid off in 60 more days!! But think of the men that could and would do this if the price came down?