Long term use of corticoids to reduce BPH symptoms? Does anyone have experience

I had my first visit with my local urologist yesterday since I had my PAE with Dr. Bagla, sept 28.

I'm 74 and all my symptoms have returned.  Maybe a little milder at the moment but they have been getting worse daily for the last month.

My urologist was very discouraging, of course he wants to do a turp but he said he saw no change in my prostate since my pae.  

I asked him if the month of wonderful relief that I had after my pae could be due to all the meds and injections Dr. Bagla gave me.  

Yesterda my urologist prescribed Flomax and a long acting corticoid shot.  Today I am feeling great.   I'm pretty sure its not the Flomax based on prior experience.  So I started getting curious about corticoids which I know nothing about.

The possible side effects of corticoid seem horrible.

I'm due to see my urologist in a month.

jjj, Was the shot in your arm or directly into your prostate? Do you know the name of the corticoid? Did he give you any antibiotics at the same time?

I have read here about temporary improvements after either PAE, Urolift or Rezum (can't remember which) that were do to anti-inflammatories given at the time of the procedure. As soon as the anti-inflammatories wore off the bph symptons returned.

Jim

Did you speak with Dr Bagla? Sometimes a second PAE can fix it.

I got a shot of beta metasone in my butt.  

I'm a faithful reader of this forum but don't recall reading about the anti-inflammatories being the real source of relief.  What a scam this would be if it were true.

 

jjj,

The purpose of the anti-inflammatories was to help the tissue recover. As a byprouct some reported immediate reversal of their bph symptons only to have them return after the drugs wore off. Not a scam but probably just poor communciation by their doctors.

I asked about where you were injected because I read about a small, older study where they injected betametasone plus antibiotics directly into the prostate. Results were mixed meaning it seemed to help some and not others. As far as I know this is not a very common treatment protocol. 

What were your bph symptons and IPSS score prior to the injection and what are they now? 

If this injection continues to work, I personally would do more research on the longer term effects of these types of injections, and please let us know how things work out. 

In general, inflammation seems to play a very underated role in many diseases and conditions. Both corticoids and antibiotics are anti-inflammtories so who knows what conditions they may help and at what cost. All very interesting.

Jim

jjj,

Just want to clarify regarding anti-inflammatories as a source of relief after bph, urolift, bph -- and again I can't remember which one. This is not to say that many here were not helped by these procedures long term. The only point I was making is that some of the progress in the first week or so may have been due to the anti-inflammatories. Beyond that the progress could be evaluated solely on the surgical procedure.

Jim

I did speak to Dr. Bagla a couple of times.  In December he prescribed Ibuprofen  with gave me 4 days of very good relief before my symptoms returned.

In january he prescribed it again but it had no impact.

Both time he seemed to me to be very rushed and anxious to get back to recruiting new paying customers.

I don't think I would consider another PAE.  

By the way I am also having occaisional sharp pains in my abdomen near my right him.  Bagla said it might be kidney stones.  My urologist said that kidney stones would most likely cause a more regional pain and also that kidney stones did not show up on a recent ultrasound.

Most likely, my urologist said, the pain came from one of the arteries or intestines near the PAE site.

My score before the PAE was about 28.  After was 6.  REcenlty 26.  

Same symptoms, frequency, urgency, interruption, difficulty starting, sleep deprivation that makes me really miserable.

Ibuprofen helps alot but my stomach cannot tolerate it more than a day or two without a reaction.

I will do more reseach, Jim, I'll let you know what I find.

Thanks for you comments, I appreciate them.

jjj,

OK so your score was recently 26. What would you say your score now after your corticoid shot yesterday?

 

I'll respond tomorrow.  Lets give it 24 hours.

 

That's a shame, I thought maybe you had it covered by Medicare? If your prostate did not shrink after PAE it could mean he did not do it right, that's why a second one is justified. It's too early to say you should see after 6 months, have another MRI etc.

I don't see how sharp pains could have anything to do with PAE. It could be muscular if it's not kidney stones. If intestine near PAE site your Urologist must have no clue what PAE is.

It was covered by Medicare.  My share was about $2300.

But I live in Buenos Aires so it cost me about $4000 to travel with my wife, stay a week, etc.   They do some PAE here but for georgraphic reasons it not covered in my Arg. insurance and would cost me $7000 so all in all I thought the trip to Bagla would be worth it.

While the PAE was pretty much painless I'm more inclined to try something different next.

My local urologist said the same thing, its too early to see changes in the prostate.   I'll have a more specialized Ultrasound before I see him at the end of Feb.  That will be 5 months on from the PAE.  

I only have 3 clues about my sharp pain.  First they started right after the PAE.  Second they are 2 inches from Baglas entry site.  Third they unlike anything I ever felt before, broken bones, torn muscles, ligament problems, etc.  Its exactly like I'm being stuck by a pin.  If they continue I'll see a doctor.

Also curious about the Ibuprophen. Can you tell us how it helped. Did it have any effect on night time urination? NSAID's like Ibuprophen have mixed study reviews. Some suggest their anti-inflammatory properties are beneficial for BPH, others caution that they can cause retention. I guess the important thing is how they work for any one individual as BPH is not one sympton but a mixed bag that often difffers from person to person.

Jim

jjj, 

Also curious about the Ibuprophen. Can you tell us how it helped. Did it have any effect on night time urination? NSAID's like Ibuprophen have mixed study reviews. Some suggest their anti-inflammatory properties are beneficial for BPH, others caution that they can cause retention. I guess the important thing is how they work for any one individual as BPH is not one sympton but a mixed bag that often difffers from person to person. 

Jim

Bagla prescribed  1800mg Ibuprofen per day for a week  1000mg Cipro for 14 days and no exercise.   Afterward all my symptoms were gone, urgency, frequency, nocturia, interruption and problems starting urination. Everything. 

4 days later on Jan 2 I went to the gym and specifically had someone who was an M.D. watch that I did not in anyway stress or injure my prostate area.

Yet my symptoms returned the next day. 

Coincidentally 4 weeks after my PAE I resumed exercise and thats exactly when my problems returned.

Both Bagla and my local urologist say there is no obvious connection between exercise and my symptoms.

As far as ibuprofen, I think it helps but I've taken too much in my life for various injuries and problems.  My stomach is too sensitive to take more of it besides there are lots of side effects. 

I live in Denver - there is a surgeon here Dr Nutting who does PAE and you can stay at my house for free with your wife if you want to cut down on travel expenses. Maybe Dr Nutting will be happy to talk to you if he thinks there is money in it for him and you can ask him about the sharp pains he might have ideas. He charges a lot but if Medicare pays I don't see it will be any different.

Anyway hopefully you will improve in the next couple of months, I find if I don't drink alcohol I sleep better :-)

Also, that much ibuprofen can be bad for your kidney. Hank

So as soon as you stopped the Cipro and Ibu the symptons returned? If the corticoid shot doesn't work out, it would be interesting to see if you repeated the Cipro and Ibuprofen, no exercise regimen that Bagla gave you, if the symptons would again disappear. Have you tried a PPI with the Ibuprofen? They are often prescribed together to ease stomach upset.

Jim

Mike, thats an incredibly generous offer.

I'm turned off on the whole idea of PAE's, Urolifts, etc.  All these procedures seem to have too many failures and leave people worse off than they were before.  

When I decided on PAE almost a year ago it seemed that it had consistently good results.  Lately more reports of failures.

I would like to take you up on one part of your offer.  I'd like you to ask Dr. Nutting about my pain.  It's occaisional, doesn't last long, it feels like a pin sticking me inside my abdomen about 3" from my groin where Dr. Bagla made his incision.  And the pain is midway between the front and back of my body.  Its not a muscle or ligament problem, nor intestinal.

It started right after my PAE.

I hate to say it but it feels like something got left inside.

OK I will call him - maybe private message me with your phone number in case he wants to talk to you.

It might seem lots of failures, but bear in mind a message board like this is more likely to attract people who have had problems, not the success stories :-)

by the way I have seen Dr Nutting, however I chose to go with the Australian surgeons since I'm from there and feel more comfortable with the Australian system

Yes the symptoms returned immediately.  

I'm really at my lifetime limit of Ibuprofen, I had arthritis years ago and used alot of it.

Having recently read about the long term risks, I'm not going to take any more.  

Two doctors have told me that the last round of cipro should have killed any infection that was there. 

Despite my BPH problems, sleep interruption, etc I've restarted my exercise because my program is specifically designed to prevent my arthritis from returning by flexing my joints, building up the muscles in my back to support my spine and also giving me cardio exercise, etc.  

These are tough choices, I'm really unhappy that I feel alone and abandoned by the medical community in regards to post-pae maintenance.

 

jjj,

I understand your reluctance with more ibuprofen. Just postulating that the post PAE scenario you state, may have as much with the the inflammatory process itself as with the PAE procedure. That would also account for the rapid results from your recent corticoid injection.

There is a fine line between prostatitis and BPH with symptons overlapping. The ibuprofen, Cipro, and your corticoid injection are all have anti-inflammatory effects. Exercise can have the opposite effect, and in all due respect for your doc at the gym, I don’t think you can easily say which exercise will or will not affect the prostate, especially after the recent insult your prostate had with the PAE. This doesn't mean of course to stop exercise, but to be cognizant of the fact it may play a role at times.

As to the sharp pain near the incision. Have you had an MRI or CT Scan of the area. Given the timing and proximity to the incision area might not be a bad idea to have a look to see if something shows up.

Jim

If I have no change from the PAE I'm  just wondering if my original problem was inflammation. 

I agree.  I think there is a connection between exercise and my symptoms coming back.  The connection is just not visible yet.   

The pin pricks seem like they are subsiding.  If they continue or get worse I'm definitely getting a a picture of whats going on in there. 

 

It's not that I don't believe coincidences sometimes happen it's just that I'm very skeptical of them! And unfortunately while docs are trained very well  in protocols and procedures, often they either aren't very good at, or just don't have the time, for good deductive reasoning which is the basis for a good diagnosis. Do you really think they go home at night wondering about why your PAE failed, whether you needed one in the first place, and what they can do to fix things? Yeh, I would get that picture, and hopefully you won't find any instruments in there

Jim

Hi Jim;

I started tamsulosina night before last and got my corticoid shot at the same time. So its been about 41 hours.  

I've already got some side effects, headaches, irritability, red face, difficulty falling asleep.

Now my IPSS score is 12, down from mid-20's a few days ago.  I can't guarantee what role Tamsolusina played. But I'm planning to go for a long drive today and enjoy my vacation from IBH.

Bagla told me the steriod was for the fast inflammation reduction of the gland and that is exactly what it does. It is the very reason that some of his patients get immediate symptom relief. It certainly is not because the PAE treatment did it, the gland cannot atrophy that fast. It takes time just like it does with a broken arm. I had that corticold shot in my right butt cheek for a bad cough last year and it really helped my BPH. But the shot was a very painful shot in the him. I did say some bad word because the nurse did not warn me it would hurt like that. 

jjj,

Speaking of "coincidences", a couple of days ago I had a very near call with acute retention, but with some effort (and a few squats) was able to do a natural void although with some blood. (Given the blood I probably should have cathed at the first sign of resistance but didn't want to break my 3-month no cath record As mentioned, this hasn't happened in over three months and things seem back to normal now. Of course I cannot be sure, but the only thing different that day I can remember was lifting some very heavy sand bags which might be equivacle to a weight workout at the gym. I have been sedetary lately but it will be interesting to see how my voiding situation changes, if any, when I get back to the gym.

Jim