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

I'm hopeful but skeptical. I read the full article in the Prostate Journal and in the introduction there were two statements that I found troubling. They wrote "At the moment there are no therapies that meet all objectives. The available therapeutic options are surgical or pharmaceutical, each with pros and cons. Transurethral resection of the prostate (TURP) has been the gold-standard treatment in men with symptomatic BPH. However, the morbidity of TURP approaches 20%, and less invasive techniques being developed are reducing the need for this method [9]. Available drug therapies for BPH fall under two general categories: alpha-blockers and 5 alpha-reductase inhibitors, both of which can improve urine flow, but they do not reduce the size of the prostate, and can contribute to sexual dysfunction or hypotension as side effects."

To claim turp morbidity approaches 20% is just not true. And to claim that 5 alpha-reductase inhibitors... do not reduce the size of the prostate is also untrue. Many double blind studies have shown that 5 alpha-reductase inhibitors like dutasteride have reduced prostate volume by 25% in 6 months and the prostate size stays shrink for two years as long ast the medication is taken.  

The authors are either mistaken or being untruthful. In either case it doesn't speak well for the truth of the rest of their findings.

The study wasn't a double blind study but could have been. They could have given half the dogs the PEMF and the other half an altered machine that produced sounds and vibrations but no PEMF (a placebo). The persons doing the PEMF should not know which group their dogs were in. Finally a valid study would have had follow up on both groups. Even if the PEMF did shrink the prostate, the effects could have been temporary, possibly the result of other conditions in the study, like testing the dogs' semen. 

But if you want to buy a machine and use it, I'm pretty sure you could do your own study. You would just need to get ultrasounds to verify any results.

Bob

Good critique of the study Bob. In reading the footnotes of the first human study of the PEMF there was mention that at a certain power prostate cancer was killed and at a different power it was accelerated. To me that means the calibration is critical and it's hard to research. I have someone in mind who might know and I'm going to ask him soon.

Spoke to Dr Isaacson yesterday. Really liked him. He said risk of cancer from radiation was minimal and there are some strategies to mitigate effects of contrast dye. I live outside NYC so a trip to UNC is long. Plus you are comitted to returning at 1,3,6&12 months for evaluation. Plus they usually don't take people with more than 200 ml of retention or if they are cathing. I am cathing (more as a preventative measure) and have 3-400 ml retention. He said the success rate is inverse with the amount of retention. Of course they want their study to look as good as possible so they have more rigid parameters than if you are paying for it. Does anyone know if Dr Bagla at his new place is still accepting patients in a study so you don't have pay full tarriff?

While I'm waiting I'm still investigating PEMF (pulsed magnetism)

Seems like PAE is starting to be offered all over the place but I have heard not to go to anyone who has done less than 50 procedures. 

While I

Dr. Bagla told me that he will be starting a new study in collaboraton with Dr. Isaacson in the middle of next year at the earliest.  The bad part is that you must be local.  Dr. Bagla is the one that told me to have someone do PAE that has done at least 50, but this is difficult since it is new.  Bagla has done about 300 according to his estimate. Northwestern Univ is doing a study that I was suitable for, but they wanted my private insurance to pay for it.  If you are on Medicare, there is a good chance they will cover PAE anywhere.  We are at least 2 years out for PAE to be officially approved by the FDA.    

Thanks for the info. I wonder if Medicare would cover Bagla's PAE treatment even without a study.

Hackensack University Medical Center has been offering PAE. The hospital is about 4 miles from the George Washington Bridge. Just Google Hackensack UMC PAE. The first entry should be the hackensackumc dot org site. If the Avodart I'm taking now doesn't reduce my prostate size over the next 5 months I will consider a PAE at Hackensack. I'm sure they will tell you if it is covered by Medicare. If you find out, please let us know.

Bob

I actually use a hypertension clinic there. They are known to have good doctors. Personally I would wait until they have done a bunch of them. I'm still curious to find out if its a medicare covered procedure yet. Also whether the urolift might conflict with it. Isaacson implied it might but I didn't pursue his thoughts on that which was a big oversight on my part. 

I would consider PAE first before Urolift.  PAE has the least side-effects because it is not a transurethral procedure.  Urolift is contraindicated if you have an enlarged median lobe.  Urolift does not shrink the prostate, but staple it aside to eliminate the impingement.  I would call Luz, Dr. Bagla's coordinator, for Medicare coverage.  She told me PAE was covered by Medicare.  

Since I had a Urolift already I have to consider PAE after. I would question that the Urolift has more side effects. It is touted as the least minmally invasive of all the procedures when you consider the PAE has to go through the arteries or viens and occlude many of them to kill of part of the prostate. I believe it's  more technically challenging since the veins and arteries have to be mapped out and are unique to each individual. Urolift is like an advanced cystoscope. Absolutely true that the Urolift doe not shrink the prostate and also does not usually reduce retention issues. It is generally considered a  temporary fix for those who wish to avoid drugs and have some immediate relief with a minimally invasive procedure.

Thanks a lot for the info on Dr Bagla. Really helpful.

I have also researched that, and I believe that you are mistaken. US MEDICARE will NOT cover PAE unless one of three things happen:

1. You are in an officially sanctioned PAE study.

2. Some financial person screws up and uses the code for someone who is in the study for a patient who is NOT in the study.

3. FDA finally approves the PAE.

Neal

I suspect you are correct, except I think that prostatic artery emboliztion is FDA approved for male fertility problems. I think the prostate shrinkage was a beneficial side effect. Viagara was first used to treat pulmonary arterial hypertension. I guess erections were aother beneficial side effect. Leads me to believe medicine is about 30% science, 40% marketing and 30% guess work.

Other reasons to be covered are bleeding or hematuria. If you are have had that, most insurance will cover.

I asked Luz, Dr. Bagla's coordinator, at his new office if Medicare has been covering PAE.  She told me yes.  I am only quoting what she told me.  Dr. Bagla told me directly that some private insurances are covering it providing they don't explicitly state in their policy that it is investigational/experimental.  I'm quoting him as well.  They are in the business and hopefully know how they are getting paid.  

This is for everyone on this forum.  I want to help anyone that is suffering from this malady and still looking for a sensible way to correct it.  Whatever office you decide to have this done in the US, ask the contact person whether it be the doctor's nurse, coordinator, or billing office, whether Medicare or private insurance is paying for it.  RIA Endovascular in Denver said that Medicare and private insurances were tending not to pay after previously paying for it.  Dr. Charles Nutting's nurse said that insurances were "catching on" to PAE and paying less often,  Northwestern University said Medicare was paying and some private insurances were paying.  Dr. Sameer Gadani's office at St. Louis University said Medicare was paying and some private insurances were paying.  I would highly recommend not using this office because of disorganization.  I gave Dr. Bagla's office statement above.  It can't be stated that all private insurances will not pay for PAE.  Because embolization is done on many parts of the body already, it may be paid for.  I would get a predetermination letter from the private insurance by the doctor's office first.  The insurance company will need the diagnostic code and procedure code.  They will do a match and see if the diagnostic code is acceptable to the procedure code.  Even under a large insurance company, say Blue Cross/Blue Shield, some regions will pay for it and others will not.  Some high-end insurance policies will pay for it.  This is very individual.  Dr. Bagla stated that globally, PAE is less expensive then TURP.  I hope this helps someone.  

Thanks PAE Doc. I've had two serious hematurias of the prostate in the past 18 months requiring an irrigating cath, three surgical procedures, and a total of 14 pints of blood transfusions. Hopefully if I proceed with PAE I'll be covered on that basis.

Be careful.  When I first contacted Dr. Bagla I was told PAE was most likely covered and during the ensuing 6 months they told me they were working w/ the insurance company to get it covered.  They didn't tell me it was denied until 10 days before my scheduled PAE.  

Michael, I had my PAE in May. I am diabetic and allergic to contrast dye. I also have a pacemaker and so cannot have an MRI. 

Dr Schlapoff gave me antihistamines and prednisone injections on each of the two days before my PAE. 

I never had a problem with the Contrast dye and sailed through the procedure. It's now 7 months later and still getting better and better...My prostate had shrunk 30%, I pee like a horse and my sex life is better than ever. 

I was booked in for a Holep but pulled the pin the day before....so glad I did. 

Part 1. To PAE or Not to PAE

I had been experiencing nocturia (4 or so times a night) and stinging when urinating so I decided to visit my GP. My I-PSS (International-Prostate Symptom Score) is 12, which is relatively low. Having been informed by the GP that I had a ‘moderately’ enlarged prostate, following an anal probe, and given I had low PSA readings (2.7 to 3.4) during the past decade, I started researching the nature and causes of prostatitis and BPH (Benign Prostate Hyperplasia/Hypertrophy – the former meaning cell numbers increase, the latter cell size increases).  The research led me to the Patient UK forums and peer-reviewed journal articles concerning medical solutions such as varicocele embolization (Gat Goren procedure in Israel) and prostate artery embolization (PAE) as conducted by Professor Pisco in Portugal and by a growing number of US, UK and now Australian interventional radiologists. 

Thanks to @caringbah on a PAE forum in September 2015, I discovered that Dr Glen Schlaphoff, Director of Preventative and Interventional Radiology at Liverpool Hospital in Western Sydney, was the only person in Australia conducting this procedure, assisted by Dr Jules Catt. By late 2015, Dr Schlaphoff was assisting Brisbane (QLD) based radiologists to conduct the PAE procedure.

As part of the pre-operative process, I flew from my home in Melbourne, Australia to Sydney for a one day assessment that included a CT Angiogram and MRI of the prostate. On the positive side, the MRI shows the prostate is ‘mildly’ enlarged with a volume of some 45 cm3. Worryingly, the MRI showed a lesion in the peripheral zone of the prostate abutting the prostatic capsule.

The next step is to see an urologist (perhaps two) and find out where I go from here. I would think a biopsy will be advised, and the steps from there will unfold.

Part 2 will follow when I know the urologist’s recommendations.

Hi Stewart,

i am sure you will consider the issues and options available to you with the assistance of the urologists during the next phase.I wish you all best.

When i underwent the same preoperative process I did consider my options in case of an adverse finding. But these options were vague and uninformed.

I am now past a month since the PAE procedure and coping reletively well with many of the issues that caused the problem in first place.

I will followthe developments as you progress further.

All the best

Thanks Sam. I hope I will act wisely.

I am a US Government employee with GEHA insurance. My understanding of our policy is that it is nearly identical to medicare.  My PAE was covered at 80%.  Bottom line, my cost was $2000, insurance paid $8000.

This "Parsemus" thing sounds interesting but its a shame they do it on dogs and not men.