PAE is it the way to go as we need more feedback

Hmmm, I'm new this site and not sure you are directing this question to me, but unable to answer it at any rate, sorry!

Dr. João Martins Pisco passed away on March 26, 2019.

There are 5-year studies on PAE. Pisco et al published the largest long-term experience in more than 1,000 patients with follow-up beyond 5 years.

PAE needs more details on 2 years and up

Stome,

There are Chinese studies with MRI pictures of the prostate after PAE in 3-5 year after. Prostate doesn't disappear after PAE and even doesn't die out. IT's like heart after the heart attack. Has some areas that dead and shrunk due to induced ischemia. Prostate by itself doesn't influence erection much. Nerve bundles around prostate do. Can assure you that in 99% cases erection stays the same if not better. RE happens in 56% of cases according to the recent published Swiss study (July 2018). You can research it all by yourself.

It's still the safest remedy in cases of long lasing BPH and super-large prostate, and when all other methods are less desirable. Probably least durable. According to Dr. Pisco one of his patients had two PAEs and was able to conceive children at age 74 and 78 witha younger partner. It's probably a rare case, otherwise sexual side effects are minimal. That's well documented. Many have lasting effects beyond two years after PAE. Read on, rather than expressing doubts or listen to rumors. Still, considered experimental, albeit covered in UK and in US by Medicare and some insurances.

Generally speaking, he is correct, although 200 g prostate is the size of an orange. Should be too late for PAE, probably, HoLEP or total removal of the prostate is the way to go. PAE will shrink it to 140 g at most, which is still too large for normal life and urination. 60g-120 is a usual optimal size for best PAE results. Many failures result from a too small prostate. According to recent MRI study from China, median lobe shrinks the most during PAE (38-40%), so the legend about large mediallobe (that by itself is the smallest prostate lobe, but true, is the closest to and engulfing the bladder neck. Legends about enlarged median lobe being contraindication to PAE is most likely a typical medical fallacy stemming from poor understanding of the anatomy and how PAE works.

Gene, I believe his point was (that I should have explained) is that PAE can be used as an intermediate step to reduce it to a size that is treatable by other means including other procedures. I don't want to quote him or swear that was exactly what he said and meant because he's not here to clarify, but that was the general sense I got. He did say he got a lot of business as referrals from urologists on problem cases.

That sounds reasonable. That was my idea, to make it manageable by other means (Resum, plasma TURP, etc.). It turns out , I am fine for now, but might need intervention in the future. Too early to tell. Very happy for now and regret that I didn't do it earlier in my late 50ths or early 60ths. Probably could have preserve the bladder wall and neck, albeit not too many complaints currently.

The prostate has plenty of cross connected arterial blood flow that originates from arteries feeding other nearby organs such as the bladder. When the left and right prostate arteries are clogged up, it's done downstream where the branchings get to a certain size. Often the IR uses 300-500 nanometer spheres to silt things up, well before the capillary sizes. Capillaries are commonly 7 to twenty some nanometers, a red cell is about 8, but squeezes thru. But after the PAE, blood flow continues from these other arterial supplies. I'm interested in what has happened with the vasculature when an IR decides to do a second PAE. I'd like to see that MRA (pre PAE) with some expert info overlayed, such as would be used for teaching. I've watched some videos used to train IR's and the imagery along with pointers overlayed on the image along with the lecture from the professor really helped me understand the technical aspects of the procedure.

About right, but nevertheless in the successful PAE blood supply is terminated (or dramatically diminished) to some parts of the prostate, which leads to the acute ischemia and death of some tissue. Pretty random (except in so called TaRGetted PAE). Dead tissue is most often absorbed by the body. I didn't see any blood or clots in my urine. Second PAE has much less success rate due to the few arteries that can be still embolized. They are still some and new vascularization, of course. It could be seen on the pre-PAE contrast angiography of prostate arteries. Second and thirs PAE area rare and leas only to 15% volume reduction.