My Prostate Artery Embolization with Dr. Bagla, Jan 2017

Generally reported success rate for PAE is around 80%. Dr Bagla reports a higher success rate (low 90's). He said that he is very selective in who treats.

Rich,

Like any statistics, the devil is in the detail.   

The only survey Dr. Bagla has sent me was at the PAE+30 day point.  Thats not a valid point from which to judge results.  Its too soon for the PAE to have made much change and its also at the point where the patient is benefitting from all the steroids and anti-inflammatories given during the procedure.

When I got the survey I was feeling great and reported my success, undoubtedly earning me a place among the 80% or 90%.

However immediately afterward my problems returned and now, at PAE+5months, I'm sufferring exactly the same as pre-PAE.  Yet there has been no survey to record the failure of my PAE.

 

Hi jj,

  Your reply makes a lot of sense. I did look at a paper on the nih website that did follow-up for 24 months, and they reported very positive results. (I'm not a scientist, and some of this could be over my head.) I'll copy a quote from the abstract resulst and conclusion section below. What are your thoughts on this? Happy to PM the link to the whole study.

Results

The prostatic artery origins in this study population were different from previously published results. PAE was technically successful in 109 of 117 patients (93.2%). Follow-up data were available for the 105 patients with a mean follow-up of 24 months. The clinical improvements in IPSS, QoL, Qmax, PVR, and PV at 1, 3, 6, 12, and 24 months was 94.3%, 94.3%, 93.3%, 92.6%, and 91.7%, respectively. The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P?<?.0.01), the mean QoL (5.0 vs 3.0; P?<?0.01), the mean Qmax (8.5 vs 14.5; P?<?0.01), the mean PVR (125.0 vs 40.0; P?<?0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P?<?0.01 ) at 24-month after PAE were significantly different with respect to baseline. The mean IIEF-5 was not statistically different from baseline. No major complications were noted.

Conclusions

PAE is a safe and effective treatment method for patients with LUTS due to large volume BPH. PAE may play an important role in patients in whom medical therapy has failed, who are not candidates for open surgery or TURP or refuse any surgical treatment.

I guess it does make some sense but if the bladder is not in good working order no procedure is going to work.  Have a good day  Ken

Thanks Rich,  

I believe this is the same report that we read when I was deciding on a PAE.

I have forgotten about it.

My wife and her son are both M.D.'s and medical researchers and both read the report and felt that it showed high success rates with low risk of complications.

As I am approaching the 6 month mark, I must be in the unlucky 6.7%.  

I still have some hope that the PAE is shrinking my prostate.  I'm going to have an ultrasound next week to see whats going on.

 

jjj, I am so sorry to hear about your six months results. If you wish to talk please contact me after your ultrasound. I will give you the details of my FLA. I have had excellent results and would tell you all you want to know about this procedure as I kept a detail daily diary for reference. I also know my doctor would talk over the phone to you and your wife and he would not charge you anything.

I had full 100% symptom relief after a month and do not believe that there is anything more I can improve on in regard to this. My doctor in Houston says it will improve for four total months after the procedure. Logic being that the prostate is still reforming for that lenght of time. As I said, I dont need anything more. I am better in every aspect than I ever thought I would get from the procedure. The only thing was a sexual side effect in that all of it including ejaculation improved back to like I was in my thirties!!! Never expected a positive side effect. 

Good luck and keep fighting this condition. You can do something else which is one of the reasons to choose PAE a procedure. It does not limit you later. I was going with the same idea but with FLA first then PAE if I later needed. That will not now be necessary for me. But, Let me know if I can help you. 

You are 100% correct in your analysis of that situation. The gland cannot atrophy that quickly as the blood cut off from the gland takes time to work and does not always atrophy in the same fashion or in any specifc location needed for every patient. It is a totally random procedure, effect, and results.  Large median lobes in the transitional zone cause issues for most procedures. This was a deciding issue with me as I had a problem there. FLA does not have issue with this condition and was successful for me. 

With a focal laser approach from an Interventional Radiologist that is totally visual in real time during the procedure, you can get the specific tissue removed that is causing the issue. The  doctor  also directs the path of the laser into the gland and the laser is not turned on until they get the laser to the point inside the prostate where they wish to ablate. They ablate, turn the laser off, then remove it. This allows for very guided ablation of targeted tissue. The laser is controllable up to milimeters. Enterance of the laser into the postate is rectal and not up the urethra as in most Urologically preformed procedures which have no eyes on the process while it is being preformed. 

I am sure you are already aware of this and I say it for others considering the different procedure for themselves.

Mark, success is in the eyes of the beholder.

There is clinical success and then there is symptomatic success. They are different and mean two totally different things.

I was told this by Dr. Isaacson when I visited him at UNC the day after visiting with Dr. Bagla. I ask why he and Bagla had such different percentage numbers when it came to quoting succes rates. 

This made a lot of sense to me and was Something to consider for sure.

j12080, I hadn't heard of Focal Laser Ablation until seeing your post a week ago. In the meantime I went on YouTube to view this procedure. Although I was not able to spend a lot of time viewing all of the video's about FLA, I did seem to see a thread that FLA was mainly used for men who have prostate cancer. Did you have a cancer issue? If not I assume FLA can be used on men without a cancer problem which in turn helps shrink the prostate? Any info would help, Thanks. Pete

I spoke with Dr Bagla about his success rate, and he assured me it was symptomatic success, not technical success.

Please keep us posted. Here's hoping that the U/S shows something that is easily dealt with.

Don't you think men would rather have technical success not symptomatic success.  Just thinking  Ken

Pete, You are somewhat correct to that FLA is a low to intermediate  cancer treatment  and is highly successful with cancer that has a Gleason score of 7 and less. Intervention Radiologist's (IR) do many types of treatment all over the human body. They are different and not to be confused with a regular Radiologist. My 85 year old Dad had his heart ablation by an IR for cardiac atrial fibrillation earlier this year and it was completely successful. 

Dr Kara manian is my IR doctor and he has ablated in the brain, heart and liver in some very complex cases over his career.

During the PCa (prostate cancer) procedures, IR's learned that when ablation was performed in the Transitional Zone which is the one that surrounds the Urethra, they had a large astounding number of patients claim there BPH Symptoms reverse and improve. This caused them to take note. Naturally, they saw a high purpose in treating PCa but the procedure makes so much sense as a treatment with all the logic to the answers of what we needed for a great BPH treatment. 

You did not hear about it just like you did not hear about PAE, another  IR treatment because the powerful Urological Industry does NOT want them practicing in their area of expertise. They do not want the competition regardless of the fact that the FLA and PAE are truly the best things going right now. It will be hard for the urologist to find a better treatment than FLA unless it is a cure.

NO, i did not have cancer. I had full blow BPH with a large median lobe protruding into my lower bladder  and pinching off my urethra just below my bladder neck. I will personal message you my email and my phone number and I will be happy to educate you as to what i have learned about the treatments and about my successful treatment.

Hi Ken. Sorry, wasn't clear, technical success refers to being able to get the microbeads into the appropriate arteries. Symptomatic success means that the LUTS symptoms are lessened, which is what we all want.

Rich

And with PAE, if there is symptomatic success, there must have been technical success also.

 

Thank you.  When I read that it did not make any sence to me.  Now that is clear  Thank you  Ken

Hi - j12080, I'm also very interested in what you have to share.  I'm at a very critical decision point.  Could you please also send me your e-mail for further contact?  Thanks a million for all you shared so far.  Nick

Hello Nick.  You will be very impressed with the MRI before and after pictures .  The doctor did a great job for him and did everything he said he was going to do.  Take care  Ken

JJ

I am a Patient Forum friend of John's.  John had his FLA done by Dr K in Houston December 19th and as you know is having EXCELLENT results.  I am tentive on the list for a Clinical FLA Trail that Dr K is going to start in February.  I just ran across this particular Forum and I am very interested in your results.  I think that I will contiue to commit to the FLA procedure, but after almost 5 years of following different procedures around.  I narrowed my choices to PAE with Dr B and now, thanks to John, FLA with Dr K.  His Clinical Trail will not be Free, but it should be worth the money.  If John had not had such Great Results I would be on my way to see your Dr B.  He is absolutly the BEST at PAE in the country.  This procedure started in Portugal about 5 years ago and then to Sao Paulo Brazil.  I was so excited, that I would have been will to travel to either of these places to get it done.  But then I started reading about your Dr B in Virginia, that I decided to check everything out and wait and see some of his Clinical Trail Results.  He is the IR organizations number one spokesperson in the US on that procedure.  He has written many articles and been involved with several tests going back 3 or 4 years with his first patient.  I am trying to not get BLEEEPED on this site by naming formal names.  John has had a lot of issues with that.  From all the Clinical Trails Info on PAE and everything I have read about Dr B, you will adventually be Great as well.  Again, with these 2 types of procedures, there is always the abiliity to go back in and try it again with no harm to you.  

Let me know how things start improving over time.  PAE results will take longer to clear up all of your BPH issues because it is a starving process, and as the prostate starves for blood it has to get smaller for what is available.  You should be about 100% no later than a full year.  Where John's FLA procedure is immediate after the prostate heals and reforms itself.  As far as I know, John was the 1st to have the FLA for BPH only procedure.  Dr Sperl  g in NY and Florida claims to have done 80 or more, but neither John nor me ever got any varification back on his patient feedback list to be able to contact them.  JJ, if you want you can PM me as well, but John is the Clinical Pro on Prostates.  Maybe that is what we should call him, Ha!  Contiued Good Luck JJ, you made a good choice.

Mike          

Mike I think you are making the right pick for you.  FLA is a great procedure.  John recovered very well.  Let us know how things go.  It is great to find a doctor that tells you let it is and give you what he tell you.  PAE is a good procedure also.  Take care  Ken 

Nick I just sent you a personal message, call me when you can talk

John.

Did anyone saw the study or literature on FLA for BPH. I comb all National Library of Medicine and didn't find even one article. All articles are of treatment of prostate cancer.

Vitaly Yes it has been preformed widely and is common for PCa. The fact that it can work for BPH was discovered while doing prostate cancer treatments. Treating BPH with fla is much easier than creating prostate cancer with FLA. Why has this not been commercialized? Well the first reason is because Interventional radiologist are out numbered by urologist about 200 to 1. The Urology industry has commercialized every treatment they can get their hands on. Whether they have a success rate which is acceptable or not. They still try to push their discipline on men with BPH issues.

All the fact about fla are very logical and makes a lot of common sense regarding the reasons for the success and why is should be long lasting.

Success for BPH symptoms with fla was something that was found quite by Medical observation and by testing and developing the procedure. When tissue was removed from the transitional zone of the prostate they noticed that BPH symptoms were removed and gone from the patient. By using the 3 T MRI in the procedure and locating the stricture which was pinching the urethra and focusing on the removal of that tissue specifically the success rate logically will continue to be very high. Also urine retention was improved because the tissue of the median lobe which was pressing into the bladder could be taken out of the bladder causing it to settle back into place.

Prostate artery embolization and focal laser ablation are by far the best to procedures going. PAE is a random targeted solution and FLA is a specific Target solution both have had great success. FLA is limited in its exposure because it has not been done as long for BPH as pae and the Urology world will certainly not bring it to your attention. But we see them scrambeling to come up with a competitive treatment they can say compete with FLA and is as good as fla One IR doctor that I know of claims to perform fla for BPH says he has done over 80 procedures but he cannot provide any references of patients to discuss their procedure with. I am not saying that he is not telling the truth but I will say I have tried for more than six months and made at least 10 request only to be ignored and not ever given the information. A great IR who is trained and skilled in prostate tissue removal can actually show you where he will go and exactly what tissue he will remove before you do the procedure.

As far as I know, I am the only patient that has had fla for BPH and is willing to discuss it with anyone who wants to know everything about the procedure including, what I researched to decide on FLA for my treatment and what I went through during the procedure and what my results of the procedure actually are. If this is of interest or helps someone, it is what I wish to do as I feel that telling and helping others is what my God wants me to do. Both pae and fla are good, they are just different with a different philosophy and a different approach to removing tissue . In the end I picked the one that I thought would be specific , fast results, safe , long lasting , and afford me the luxury of other options if it did not work. Most of all I demanded no sexual side effects in my treatment. Zero.

In terms end, I had to chooe between the two procedure after 20 months of hard research. I am happy with the choice I made for me and I hope everyone else will be happy with what they choose to use for their symptoms of BPH. I hope very soon we will have several other men who used this patient info site too also report on FLA. All I can do is report the facts as I know them to be and help anyone who wants information or needs support.

Hi, Mike. Thanks for your informative post. Quick question: Is that Dr. Dan Sperling of the Sperling Prostate Center?--Don

Don, I used Doctor Karaman ian after I researched this for about 20 months I visited doctors including Sperling in Florida and Bagla in Virginia and Isaacson in NC and Busch in Tennessee and several others. I was on a mission to find out what was best for me. I had a 125 cc prostate. My PSA was 5.7.

Atfer meeting for 3 hours and speaking on the phone many times with Dr. K. I had learned so much of the prostate anatomy over the 20 months that I could ask specific questions of all these doctors with regard to what the specific risk were to the specific parts of my gland. My bottom line in this process was I demanded no sexual side effect risks. Outside of a mistake by the doctor, PAE and FLA are the only treatments that offer that.

I can tell you that since then, I have learned that post op attention and care by the doctor in respect of him being there with you to support your recovery is an absolute must. I found that in only one doctor. Dr. K treated me as if I was a cancer patient in the fact that he called me every night to check on me an have me read him my log. He would talk me through my concerns. I think the other men on this posting site have also witness his level on concern for patient and I can tell you it does NOT change after he is paid. He went above and beyond for me. He had a very involved cancer case already scheduled on 12-19--16 and I would not agree to do it any other day. This was a personal thing that was an issue because of my job. I had to do it that week. Dr. K tried to talk me into waiting and when I would not do so he arranged for his associate to do the computer laser program  at the facility. Dr. K did all the componets of the procedure and was right there with support for me the whole way. His post care was amazing. The FLA is driven by the computer with an MRI monitoring the process. I will be happy to personal message you my contact info and his info. He will be happy to speak with you for as much as you wish to talk and he will not charge you as the other doctors did me when I went to interview them.

Don, I just sent you a pm with the right doctor that Mike was telling you about and the  contact info for Doctor karamanian. I also sent you in the pm my contact information and you are welcome to call me. Please let me know if  you recieved this personal message? Thanks John

John, I did receive it--thanks very much. I live in Arlington, VA, just a few miles from Dr. Bagla's new office so if I decide to try surgery, I'll probably go the PAE route. FLA sounds very promising, but as I understand it, it's new as a BPH procedure, while PAE has a bit of a track record. And I'm a little reluctant to have a procedure done away from home, in case there were a need for follow-up care. But I greatly appreciate your generous offer to talk to me. I just may do that! Is there some time during the day (or evening) that's better for you? Thanks again, Don

yes sir good choice. I messed up and sent you Uncklefesters post I was sending him on another thread that I am having trouble with. Just disregard. You are making a good choice and you have a great young man in Bagla. I would not advise Sperling but Bagla, Isaacson and Karamanian are very good Interventional Radiologist. I am sure you will be very happy. 

Yes please call me. I visited Doctor Bagla in VA and I will tell you all about it. Afternoon and evening are good for me and if I miss the call I will call right back. 

I look forward to meeting you. Sorry about the miss placed message earlier. I do that sometimes. FLA did nothing for my brain!!!

John

John,

How are you doing 5 months or so after your FLA procedure? Is it still a procedure you would recommend?

Hope you're doing well.

Don 

Hi Mike,

I'm very glad of your FLA success, I'm 60 living in Houston and have had a BPH for over 10 years. I am trying to decide whether to have PAE or FLA  if you could please share the doctor info and any additional comments you may have. Thank you

my email is victorb256@gmail.com[/b]