My Prostatic Artery Embolization (PAE) process

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My BPH (Enlarged Prostate) started sudden and severe state at 2010.

I will not explain the healing process. We decided to continue with medication.

I went to John Hopkins (2014) and went through the whole nine yard of Dynamic test and other evaluation to do the green laser surgery. My wonderful GP voted against it mainly because of known side effect.

Avodart increasing side effect on sexual incompetence and other physical side effects are overwhelming.  Hence I have started going through Prostatic Artery Embolization (PAE) process.

We reside close to INOVA Alexandria Hospital, VA.

They are very organized and responsive. 

Documents were emailed to me, upon completion and my request they provided an interview time. I will explain in more detail what I found out about the procedure and expectations from the interview (2-2-16).

I had my detail prostate MRI with Contrast agents yesterday (2-4-16)

The MRI will show in detail if I am a good candidate for this procedure or not. Not everyone is.

If I decided that the PAE will improve my condition, we will be scheduled for end of February or beginning of March.

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  • Posted

     Interview with INOVA.

    We met with very informed nurse practitioner and the DR. Sterling that will provide the procedure.

    Extremely helpful, very patient focused and informative(3).

    Because of my prostate size (65g to 70g) and age(68) I am a good candidate.

    But the procedure is not a permanent solution and it’s mainly to reduce the symptoms and hence it may have to be repeated.

    I was informed that the enlargement of the prostate is because of what they called PBH Nodules.

    BPH involves hyperplasia of Prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the transition zone of the prostate. When sufficiently large, the nodules impinge on the urethra and increase resistance to flow of urine from the bladder (1,2).

    BPH involves hyperplasia (an increase in the number of cells) rather than hypertrophy (a growth in the size of individual cells).

    These PBH Nodules have dedicated blood supply and makes them grow or sustain their size. Prostatic Artery Embolization (PAE) blocks or decrease blood supply to the prostate Nodules.

    During the procedure, a small, spaghetti-like catheter is placed via an artery in the right groin into the arteries that supply the prostate. Very small particles are injected into the prostate arteries to decrease blood supply to the prostate Nodules, thus reducing its size and symptoms.

    I was tolled since they use Magellan Robotic System allows them to be more precise and efficient; they will be able to direct the spaghetti-like catheter toward the prostate Nodules.

    If the formation of these prostate Nodules are around prostatic urethral, the procedure will help significantly. If Nodules are around out edge of the prostate it will not help as much.

    The Purpose of MRI and MRI with Contrast agents is to find the location of the prostate nodules and also improves the procedure accuracy.

    I am waiting for the MRI result.

     

     

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    • Posted

      I appreciate the detail, since I am considering PAE for future if my 4x/day CIC ceases to provide suifficient relief.  Right now I'm fine, with post void residual reduced to less than 400 on average CIC, and only the occasional need to get up during night to pee.  My urologist, of course, had been pressing me to do TURP, and has never mentioned PAE.
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  • Posted

    Thank you - did they way why someone would NOT be a good candidate?  Good luck!!!
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  • Posted

    I am glad that you had a doctor that cared enough to say no to the green light.  He cared about you.  Any of the proedure that start to cut or burn or core at the prostate will ness up your sex life.  Most of the time they tell you it will be ok but it is never the same..  Gook Luck  Ken   
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  • Posted

    Expectation and Risk

    They told me, everything will feel worse for the first two weeks. I may feel the improvement within 1 to six month. I cannot stop my medication unless my urologist will see improvement which will take anywhere from one month to six month.

    The procedure is not a permanent solution and it’s mainly to reduce the symptoms and hence it may have to be repeated. It will keep the option open to do other type of surgery including green laser.

    The greatest risk involve in this procedure is when a small, spaghetti-like catheter through artery moves to other part of body including Balder and Penis.

    In past five years, since the start of this process at INOVA they had no such issue. The Dr. Sterling assured me that he is extremely careful and this is what he is best known for at INOVA.

    Since Medicare pays for 80% and my other insurance will cover the rest, my only concern is the fact that I have to continue with medication at least for few month and may have to repeat the process in 4 to 5 years.

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  • Posted

    Do you know your prostate volume? I had PAE July 2, 2015 at St. Louis University Hospital in St. Louis, MO.  My volume was 80cc at the time of the procedure. The interventional radiologist was only able to embolize my right side through the right femoral artery. Still, the improvements have been dramatic - I was getting up hourly prior to the procedure, now I have at least one three hour period of sleep each night. I had similar reactions to all of the BPH medications, and not taking any at this time.  I expect to have a follow-up procedure this summer to get the other side.  By the way, my insurance covered the procedure 80 - 20.
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  • Posted

    Thanks, sounds like they are giving you lower expectations and hopefully you will see quicker and better results that are long lasting. Re medication maybe you can switch to something that will not make you impotent?
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  • Posted

    Siakzar,

    Good luck with the PAE. I had mine done April 1st, 2015 at UNC Chapel Hill. My results were positive and almost immediate. I quit taking BPH Meds the week before the procedure and have never taken any since. ALL BPH symptoms are gone now and sex life has returned to normal. I saw improvements after a week and it just got better and better for 3 months until I was completely without any BPH symptoms. 

     

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