PAE and Subsequent Prostatitis

Thanks for the response, but antibiotics rely on blood flow to reach their target. It's already difficult for them to get to the prostate. Lower the blood flow via PAE and it seems likely it will be very difficult for the antibiotics to reach the prostate via the blood. Many men with BPH also suffer from prostatitis.

Anyone have any direct experience or been advised by their uro or IR regarding this question? Thanks.

Good Morning Buddy.

What you are saying is very true. Antibiotics do rely on blood flow. But with the injections they are put straight into the prostate through the perineum so they do not have to travel anywhere.

There was another guy on the other day talking about a drug for prostatitis called Monurol ( Fosfomycin ) This drug would travel in the blood . They found out that this is the only drug that will get into the prostate. The trail was done on 20 men 17 of the 20 had a 85 % clinical cure. This was in 2015.

They stop using it because the stuff they use now did work. When I see my urologist I am going to ask him about it. Maybe I will try it next time when I get prostatitis again. Instead of Cipro.

Have a great day. When we have question this is when we all learn............Ken

.

I do not have a good answer. but I had the PAE procedure 3 years ago and again this past Monday. During those 3 years I did notice I had almost no flare ups with prostatitis which I had been dealing with 20 plus years prior to the procedure.

So in my case it reduced the prostatitis flare ups.. Good question.....would be nice to have some real data on this.

Ed, can you just get PAE over and over again ? Hank

Yes you can. I just had my second one... If this one last five or so years this time and nothing better is available I will do it again. I was told there are at least three reasons why individuals are rejected for this procedure. The blood vessels are to small or to diseased, if there is cancer present some will not proceed and the structural relationship of the vessels and the surrounding organ are such that a safe procedure could not be preformed in their opinion. . I have no idea what the percentage would be ..

Hi Ed:

Can you let us know where and who did the procedure for you? Thanks.

Dr. Ari Isaacson at the Univ. of North Carolina Medical Center. He did both of mine.

How much and how did you pay for it ? Thanks. Hank

The first time 3 years ago it was totally self pay and they was given a fix price of 6500 dollars. My insurance only covered part of the CT scan.

They now have a fix rate price of 10,500 for self pay which is what they charge medicare which covers this procedure.

I have private insurance and they are covering about 70 percent of the cost. I had to pay the rest upfront before I was scheduled for the procedure. They took my Visa card. They schedule you for hour of registration and paperword/wrist band, 1 hour for prep.. port in arm, dress for the surgery suite, checking vital signs. etc , 2 hours in the surgery suite.... first 1/2 getting you and everything ready/checked including placing port in the femoral artery and then 1 1/2 for the actual procedure. They take you back to the prep. room where to lay on your back for 2 hours which is required if they enter through the femoral artery and then you must pee on your owe before they let you leave. The Dr. checks on you doing this 2 hour period.

Every time you get a PAE you are killing more and more of the prostate gland. First the embolization creates severe localized inflammation (phlebitis) followed by the immune system trying to produce local clots (thrombosis) followed by dead and dying tissue (necrosis) followed by localized fibrosis. None of this is good for the gland. Furthermore there is increased risk of embolizing close to the vital tissue of the urethra, rectum and bladder wall. Then there is the possibility of blood clots going to the heart. Also the inflammation zones create damaged tissue regions where gene mutations can occur and cancer. I had this happen to me after my PAE and the lesions were traced to the embolized regions and resulting inflammation. Thankfully the lesion was biopsied as just inflammation but it can be a precursor to cancer which is why I am having another MRI next week to check on it after 2 years. Be VERY careful with multiple PAEs. I know what I am writing here. Howard

Howard

If PAE causes "severe local inflammation," and it's often done on guys with big prostates - 150 cc and up - why, from all I have read from actual patients, hasn't one guy say he needed to be catheterized after PAE to prevent AUR?

Dr K's patients are catheterized after FLA because of localized swelling from the laser

Dr Bagla knows I have a big prostate and he told me no catheter is needed for a man who can void on his own pre PAE

I don't doubt you know what you are talking about, but Dr Bagla has done more of these than probably anyone in the western hemisphere - I recall one of his patients saying he had done 1000 PAEs

Michael

Thanks Ed.Hank

Thanks Howard for the warning. I am currently leaning towards HoLep which has an average longevity of 10 years and more robust results, especially for urinary retention. I was just wondering instead of HoLep, I could have PAE done 3 times. But from what you mentioned, it might not be a good alternative. Hank

Hank:

Who are you considering to accomplish the Holep and where would it be done? Thanks.

I am looking into it. I need to warn you, HoLep comes with almost certainty RE, which I am already getting from my meds. Also, a very small chance of incontinence. Hank

Incontinence worries me the most.

All prostate surgeries carry incontinence risk. Perhaps HoLep and TURP are a little higher but at 1% risk, I am willing to take a chance. Hank

Mayo Clinic in AZ seems to be a good choice for me. I just need to be sure the surgeon is well experienced. Hank

" The study, which looked at the durability of outcomes of HoLEP in nearly 1,000 patients over 10 years, demonstrated that complication rates are minimal and the need for further treatment, even up to a decade later, is less than 1 per cent, compared to 10-16 per cent with TURP. "

I was wrong in stating that HoLep longevity is 10 years. It's actually way better than that. Hank