Has anyone out there had a "Prostate Artery Embolization??

Just had 1 month check up. 

Prostate volume 136ml was 163ml.

Retained volume (after urination) 2.5ml , was 127 ml.

Go 7 or 8 hours at night now, used to be up 4 or 5 times.

Had retrograde ejaculation for about a year. That's not perfect, but much better.

Hungupdown, I didn't see any mention of a 6-day checkup on Dr Pisco's website.  Did you request that or was it offered?

Hi

My name Is Leonid

I d like to visit dr Bagla and have that thing dane

Any problems with erection for you now?

Any problems at all?

Thank you very much for response

leo

PAE

No problems what so ever !!

best thing I ever did.

did it on June 2nd 2015

Hi just came across this forum. Glad to see your improvement. I am an an Australian and considering Prof. Pisco. I have prostate cancer as well and can't be treated with PAE in Australia but Pisco will consider doing it. Is PAE not covered by NHS in Southhampton. If not why not? Is it considered to be too experimental perhaps? Hope you are still following this forum.

Still following this forum.In the states, so don't know the answer to your question.

Curious, what are the pros and cons of having a PAE with PCa?

There is another procedure called FLA which is written about a great deal on this blog. If you search for it on the Web you will also find a great deal of information about it. As I understand it, in this procedure, using MRI guidance, a laser filament is threaded, I think, through your rectum, and directly into the cancerous lesions in your prostate, where it destroys just the lesions. While using this technique to remove cancerous lesions in the prostate, doctors and patients were surprised to find that it also cures BPH. It has not yet been cleared in the US as a cure for BPH, but it is cleared for use on cancer in the prostate, so it is funded for cancer by MEDICARE, and most insurance companies, but not for BPH. It looks like it might be made for your situation. Importantly, it is NOT done by urologists, but by a different kind of doctor called an interventional radiologist, so it will never be recommended by a urologist since they make no money off of it.

Neal

Hi Neal,

I have checked FLA out with the only specialist who does it in Australia.

He said I am not suitable because my 2 lesions are too big and may have breached the capsule wall unfortunately, so I have moved on. Thanks for your reply and interest.

Ernest.

The primary thought is that since the cancer grows out of the prostate and grows necessary arteries for its nourishment, PAE might block the cancer arteries also, hopefully killing not only the prostate but the cancer at the same time. This is of course quite experimental, and not yet done at all, as far as I know, so knowledge of the pros and cons is limited.

Ernest.

Thanks Ernest. If the PCa has breached the capsule I imagine that you are considering other treatments as well.

Also, if you are considering Dr Pisco (in Portugal) for PAE, would it make sense to also consider FLA in the US as an alternative?

Rich

Hey Neal. 

I have made up my mind. I am going with the FLA in the next two to three weeks based on my wife's treatments. I really want to use karamanian. He is definitely the best I can find. I still cannot get the references on FLA for BPH out of sperling. I have tried 8 times. The last attempt, I was told they would have him call me. I have waited now a week and it is not going to happen. If

I have never called k that he did not return my call in 24 hours. If I cannot line up with dr K  because of schedules, I will schedule with his associate walser.  They still work together at UTMB. Maybe I can get both! Walser is the mentor but K is the genius with the bio medical engineering and interventional radiology degrees. He is really great to speak to as he never makes you feel like you are just a number that should just trust what is thrown at you. 

Last time I spoke with dr k, he was talking about doing his own clinical trial offering to support part of the cost for 5 -10 patients. I think he will make a special offer. He is really a good doctor and just saved one of my friends from a bad disaster he was getting into with a Uro. He got him a great doctor in Oregon for a special situation.  His talents are beyond anything else I can find and I am so pleased he has dedicated himself to PCa and BPH for men. 

Hi Earnest,

I'm sorry that won't work out for you.

Best of luck,

Neal

Did you see the results of a trial at John Hopkins in Baltimore under Sam Denmeade where they treated PCa with high doses of testosterone and shocked it into submission?  I thought it was very interesting.

If you want to know more google bipolar androgen therapy.

That sounds like wonderful news. I hope it works out for you. Please keep us posted on your progress. What will the FLA cost you? Where is UTMB located?

Neal

Neal, it is in Galveston and around Houston. The cost will be the normal 20k but I do not care at this point.

I think dr k is going to do a clinical trail he can do a paper on and he will subsidize some of the cost for each person out of his pocket. The equipment companies don't care yet about us BPH boys. At least enough to fund a trial. They are working on the heart, brain and cancer problems now. If dr k does this, it would be a lot less out of pocket than 20k for a few people that qualify but I can't wait. My back is against the wall on this. I must do it and I have borrowed the money already. If it works I am happy don't care about the cost. But if you can wait till he is set up and if you get in before it is full it would be a sweet savings I am sure. l will let you know. About my procedure as it goes.

Hi Jim,

Thanks for the information. I'm looking forward to reading how it goes for you, and wishing you the best of luck.

I had a second PAE, from Dr. Isaacson at UNC on 3 November, so I will need to wait until at least 3 March or so to see if that works better than the first one did, before I can commit to whatever is next.

Neal

Hi Neal,

    I don't remember if you posted info on how the second PAE went in terms of side effects. I'd defintely be interested in hearing about it.

Rich

Hey Neal, did Dr Isaacson give you any indication why the dirst one did not work? Dont know if you recall, but I had one by hm I Jan of this year, and from what I can tell I got zippo, other than a really bad prostate infection lol.

 

 

Hi Joe,

    How would a PAE cause a prostate infection?

Rich

Well a noral PAE causes quite a lot of inflammation but I also had an allergic reaction to the beads they used which caused even more inflammation that became an infection.

Oh, I remember your earlier posts now. Have the allergic reactions to the beads calmed down at all?

Just had my annual physical, the first one after my PAE procedure back in June this year. To my surprise, my PSA score jumped from a relatively stable (for the last several years) value of 5.5 to 9. The doc who did my PAE says that he sees more evidence that PAE may cause prostatitis, which in turn may increase PSA. Still, he was puzzled by this PSA jump. From literature review, PSA usually decreases after PAE by about 30%.

Did anyone else experience a PSA increase after PAE?

Hi Sergio,

    Have you experienced any prostatitus symptoms? Did the doc recommend going on antibiotics, or anything else to investigate why your PSA jumped? Are your BPH symptoms better at this point? Thanks!

Rich

 

Hey Rich, it has improved some, not nearly as much pain, but bph symptoms still worse than before the PAE. Plus I have permanent scars from the reaction😪

Hi Rich, and others who have posted here today,

I had no side effects from the second PAE, except some very minor pain in my prostate. It was not even nearly enough to bother with medicating after the first day or two. I also have my same BPH symptoms, but they seem to very slowly be getting better. I sometimes go 2-4 hours without urinating in the daytime, and slightly longer than 2-3 hours at night which both are better than before I had this PAE. But other times, it is just as it was before this procedure. I'm continuing to be optimistic, and we'll see what the next 3 months bring.

Dr. Isaacson said that the main problem with the first) PAE was that I have an extra major artery going to my prostate that most men don't have, and that he missed the first time. Also, he planned to embolise the arteries further from the prostate to make it more difficult for me to grow arteries around the embolisations. Time will tell if this is going to work this time.

Neal

Good deal Neal, hopefully this one will work for you. I sure wish you the best, and please keep us updated.

Hello Nealpros,

    I haven't posted since last spring or so. I have a seasonal business so no time to post.

   I had my PAE 19 months ago June of 2015. I had wonderful results very quickly. Perhaps a 75% improvement. (Note, I had a terrible and barbaric TURP a year before that with no improvement whatsoever).

Now I am experiencing some increase in frequency during the day.

Nights I still have to get up only once when pre PAE it was 4 to 6 times.

I'm still very happy with the results but feeling a little nervous about the future. When Dr Bagla did it they said it should last 5 to 10 years...but they really didn't know for sure about how long I might benefit.

   So now I am asking two questions. First, what are others experiencing after the fact of having a PAE? How long are the improvements lasting?

And secondly has medicare started to reimburse for the PAE?

Thanks,

Bill  

Bill;

Dr Bagla did my PAE on Sept 28, 2016. Medicare paid all but about $2200.

By the end of my first month my AUA score had dropped from 26 pre-PAE to 6.

Since then it has crept back up to 21 and like you I am nervous.

I have been unable to find any information about maintaining a PAE.

So I had an ultrasound last week that showed my prostate has shrunken 25%.

And yesterday I asked Julie, Dr Bagla's nurse about it. She said that I probably have an inflammation and recommended that I take ibuprofen three times per day, Which I started yesterday.

I'm waiting to see what happens.

Hi Joe,

Thanks for the good wishes. I'll post how it's going.

Neal

Hi JJJJ,

The Ibuprofen will normally work well, but DO NOT TAKE IT LONG TERM. LONG TERM IT WILL KILL YOUR KIDNEYS.

Neal

As far as I know, and as of November 3, 2016, MEDICARE does not pay for PAE for BPH unless you are in a study, or it is being done for some other approved reason such as blood in the urine.

Neal

Wow, you've really been through the ringer. From your question to Neal, are you considering a sceond PAE even with your reaction to the beads, or am I reading too much into your question?

Hi jjj,

   

    Do you have Medicare supplemental or Medicare Advantage? I think Medicare only pays 80% of most charges if you don't have either suppmental or Advantage..

   Please keep us posted on whether the ibuprofem works. Wishing you good luck with that!

Rich

 

Hi Neal,

    I think we've been back and forth on this before. According to Dr Bagla's office, they have been getting Medicare coverage when it's not a study. Dr Issacson's office siad it doesn't cover except for a study. I asked Dr Bagla's office about the difference, and they didn't really know why. Where does your info come from? Anyone else have info on this?

Thanks

I have only basic Medicare.

Anyone with questions about coverage should speak with Dr Baglas insurance coordinator. I did, early on. It was helpful in making my decision.

I'm going to give the ibuprofen a few days then post the results.

Jeff

I've been diagnosed with a chronic prostatitis long time ago. Maybe after the PAE it became more acute. No particular symptoms, except some discomfort in the pelvic area. My doc adviced me to take Advil, retest my PSA in 3 months and a biopsy if it does not go down. I am hesitant about the biopsy.

If the PSA doesn't go down, another option is to do a 3T MRI of the prostate to see if a biopsy is necessary. If the MRI showsone or more suspicious areas and a biopsy is advisable, then at least it would be a targeted biopsy rather than a random one.

Hey rich,at this point I do not think I would consider another one. However Dr Isaacson did say that he could use a different embolizing agent. Never say never tho lol.

My information came directly from Dr. Bagla, about PAE being only covered for NON BPH conditions like blood in your urine. Apparently, a lot of men who are operated on by him have that. Also, Dr. Isaacson's office charged me about $6,500 for each PAE.

Neal

Hi Neal,

Insurance aside for a moment, are you suggesting that Dr. Bagla performs PAE for patients with blood in their urine (hematuria) who do not have BPH? Or are you saying that he often performs PAE on men with BPH who also happen to have hematuria? The latter makes sense because hematuria is often associated with BPH.

But if he performs PAE on non BPH patients with hematuria, I'm curious what is the mechanism of how that would work and how he in fact could conclude that there may not be other causes of the bleeding.

Jim

Hi Jim,

I'm not sure how to answer your questions. The original question was about whether or not MEDICARE pays for PAE for BPH.

The answer is that it does not, unless the patient is in an approved study. It does, however, pay for it as a treatment for blood in the urine, whether or not the man has BPH. When used to treat blood in the urine, it also usually helps BPH, if the patient has that. Many men who have shown up on his doorstep for BPH have found that they also have blood in their urine, and have gotten a PAE paid for by MEDICARE.

I hope that clarifies it. If not, send me a pm, and I'll explain it further, if the above doesn't make it clear enough.

Neal

Neal,

I just saw a few papers where PAE is used to treat refractory hematuria of the prostate. Not sure if that is the same as the garden variety hematuria that many of us, including myself, have from BPH or even prostatitis. If it is, then I guess I get my PAE paid for by insurance if I decided to go that route. And same with others. Thanks for pointing this out as hematuria is not at all that uncommon with BPH.

Jim

Hi again Jim,

I didn't answer your last question because I don't know the answer. PAE must work for cases of blood in the urine, because it has passed FDA screening and has been approved for use for that purpose. The answer to the financial questions is in my earlier post.

Neal

Hi Jim,

Yes, if you have hematuria, my guess is that you get the PAE paid for. That's what everyone has been telling me.

Neal

Hey Neal, if I were you I would insist that they at least send it to your insurance, and ask for them to pay.  My BCBS of TN covered mine last year. I am really surprised that they would cover something that medicare would not.

Joe

Medicare paid for my BPH PAE two months ago.  

Speak to the insurance manager in Dr. Baglas office.

No blood in my urine

I totally understand that. How were you able to determine that it was a recation to the beads and not something else, such as the contrasting agent?

Interesting. That is not what they told me. Who did you speak with? And it was in Nov?

I had had all of the other medications used during the procedure before, And they used the contrast the day before the procedure with no problems. The reaction started within 2 hours of have the procedure completed. And the DOC thinks it was the beads because the reeaction has continued for so long, and anything else would have long ago left my body. Unfortunatly once the bead are installed there is no way to take them out, other than prostate removal.

Are you considering any other procedures for BPH at this point?

Not immediatly for sure. I had to go back on antiviotics this week for yet another prostate infesction.  I am very interested in the ablation tho, I just wonder if getting rid of the median lobe might help with the weak stream, and the prostatitis/infections.

Hi Joe,

My insurance is MEDICARE and TRICARE.

TRICARE automatically covers anything that MEDICARE covers, and nothing else. MEDICARE covers procedures approved for specific conditions by the US FDA. PAE is not approved for treatment of BPH by the US FDA. The US FDA won't cover the PAE for treatment of BPH until relevant studies have been completed. Most studies are funded by the US FDA. There are at least 5 times as many urologists in the US as there are interventional radiologists. Interventional radiologists do PAEs, urologists do not do them, so urologists don't make any money from them. If ultimately PAE is shown to be effective in treating BPH, urologists and many large companies that make equipment used in the many flavors and colors of TURPs stand to lose a GREAT deal of money, many millions of dollars, so they lobby against the allocation of the money to do the necessary studies. The urological associations have more members, and therefore more funds for lobbying.

That's why MEDICARE, and most insurance companies don't cover PAE for treatment of BPH.

NEAL

Got ya, I knoiw Dr Isaacson said mine was the first insurance that he had gotten approved, but they will not cover anythin considered experimental, so I guess I just got lucky. Now if it had only worked LOL.

Keep us up tp date man.

True point Neal. Let me point out a mathmatical fact in this war. 

The normal TRUS blind 12 needle biopy that is the second step for the Urologist rigth after the DRE is an average cost nationwide of $1,100. This simple procedure takes less than 10 minutes and is done in the Doctors office. Last year there were approximately 1,200,000 of these wonderful procedures done last year in the US. 

That is an annaul market of over $1,300,000,000 that is with a "B" as in billion. 

Now you know why they fight so hard and this is just one of the many products a Urologist has in his bag of tricks. 

Imagine having a product for sale that has that size of ANNUAL  market place. 

 

Hi Rich,

I got my information from Dr. Bagla, Dr. Isaacson, and Dr. Isaacson's financial manager.

Neal

Rich,

Yes, I did get that information in October and November, 2016.

Neal

Hi J,

I don't know, but my guess is that any TURP, done in a hospital, with general anesthesia, and frequently an overnight stay, costs many times what any biopsy costs. We're talking big bucks here .

I have before suggested that we write to our Congress people, and senators, and bring this problem to their attention, and point out that many of them will have these problems if they don't already.

This same situation holds for FLA, Focused Laser Ablation, and probably soon, other promising technologies that will potentially cut into the urologists' monopoly.

Neal

Thanks Neal. Did Dr. Bagla's office confirm that Medicare will only cover if there is blood in the urine or if it's a study? I'm planning to call Julie and go over this, and want to make sure I have all of this straight.

Rich

Hi Rich,

I believe that Dr Bagla said something to the effect that blood in the urine was one of the conditions under which PAE was covered, but BPH, by itself, was not one of them.

Neal

Hi Joe

Have you known any information about FLA and its efficacy on median lobe?

Regard

FJ

No sir I do not,and after all I have been thru I am somewhat skeprtical. But if they can remove certain tissues, such as the median lobe without damagaing the surrounding vital tissues, it sure sounds promising.

Are you still doing good with the PAE

Procedure? Do you still recommend it ?

How long has it been since you had it done appreciate your input thanks

Hi Victor, 

i had my PAE in May 2015. I'm going great guns...best thing I ever did. I really don't even think about it anymore.....it's like I never had BPH.. 

Don't worry about it...it's one of the easiest medical procedures I've ever done. 

Cheers 

peter 

Thanks my friend that's great to hear

I will be getting it done..

I guess it has been 3 years since your PAE. Have things continued to go okay with your BPH symptom reduction? I am curious about how long the PAE is effective.

How are things at the 2 year point?

Rick

Hi Ernest

I have been looking for a specialist who does FLA in Oz. I have not found one yet. Can you tell me who you found?

Regards

John

hungupdown, 

Were you taking Flomax (Tamsulosin) before your PAE.  That drug can cause retrograde ejaculation.  So if you stopped it after PAE it could explain your improvement.

Thomas