Possible BPH, looking for advice

Hope you start healing and your results turn postive!!! 

According to hungupdown who posted 23 days ago, his experience with PAE certainly bears investigating. I would like to hear more about it.

My best to all BPH sufferers. 

Ron 

Anyway, PAE is Prostate Artery Embolism, basic plan is reduce bloodflow to the Prostate which then shrinks.

Embolism is done by inserting a cathater into the artery to the point to be blocked, then feeding in PVA beads via the catheter. These beads dissolve after about 6 months, but the blood flow will stop permanently. This is done with arteries on both sides of the Prostate, I'd expected 2 incisions but only one was needed. They did the left side by going up the right artery to to the junction, then back down the left side.

Prof Pisco developed the procedure about 4 year ago, I believe the first patient was a colleague who persuaded Prof Pisco to do it.

St. Louis Hospital also does uterine fibroid embolisation, which has been around for around 20 years so wel tested. Was told that Prof. Pisco has done around 20,000 embolisms, just over 700 have been the PAE procedure. The procedure for both is very similar, main difference is the target.

Before being accepted for the procedure you have to first send in results from a few tests and fill in IPSS and IEEF forms. A trans-rectal ultrasound (TRUS), shows the Prostate size and shape.

PAE is aimed at patients with BPH, rather than Prostate cancer. A prostate biopsy is suggested to 'eliminate' cancer, but I'd already declined this when suggested by NHS. The biopsy can cause sexual dysfunction or infections, the samples taken may easily miss any cancer and interpretion of microscope observations is very hit and miss. Experts say they often return the result 'atypical' when they're not sure, knowing the ensuing harm done following a false positive.

Prof Pisco was happy to proceed without the biopsy, digital rectal examination and the TRUS image both indicated the prostate was healthy.

In Lisbon they do about 7 patients each Thursday, you have a CT scan done on the Tuesday then see Prof Pisco on Wednesday to discuss the scan. The scan shows the Prostate arteries in 3D, if the arteries are 'tortuous' (very finely divided) then PAE is less likely to be a success. This problem is more likely if you smoke or are older (over 80ish).

On the day you are given a mild sedative, a small maybe 5mm incision is made and a catheter needle / sleeve inserted in the artery to the side of the groin.

You are transferred to the radiographers table, this allows them to see the catheter placement. During the procedure a 'contrast medium' is injected via the catheter. This gives a very warm feeling but as it spread up my body I felt quite woozy for about 5 minutes. This was the only uncomfortable part of the procedure. I could feel when catheters were being moved around inside, this just felt strange.

When finished the catheter needle was removed and a nurse applied pressure for a minute, then stuck on a bandage.

The whole procedure usually takes about an hour, I was maybe 90 minutes as they couldn't get the regular fatheter round an acute bend and had to use a special one for the very first time.

You need to lie down most of the time for the rest of the day. After 2 hours I went to the toile, already a big flow improvement, I guess because the prostate was no longer being inflated so much. I was 2nd paitient that morning and left about 5pm. Got a taxi back to hotel in Lisbon, if your staying far off you would be kept in overnight.

They said the procedure was a success, embolism was achieved on both sides. If only one side is sucessfull you might get some benifits, though never as good.

Told it's good to walk around the next day, but not to drive tfor 2 days. Prof Pisco likes to stay around for a few days, in case of any rare side effects he would see you straight away.

Common side effects are blood in urine or semen. After 3 weeks I started getting blood coloured semen, dark one day but then clear after 10 days.

I had an initial Prostate size of 163ml (average adult male is 30); retained urine volume 200ml; PSA 5.6 and needed the toilet about 5 times a night. I also suffered retrograde ejaculation, which was not comfortable, despite coming off Tamulosin for the last 10 months.

Retested at 1 month, now: size 136ml (17% reduction) 2.5ml retained; PSA 3.6. Now 2 months, sometimes 1 toilet visit at night but mostly go right through. No longer have retrograde ejaculation, still not brilliant but much better, also clear which means little or nothing coming from testes.

If there's no improvement after 12 months, they offer to repeat the procedure for just the materials cost, providing your arteries are suitable (not tortuous).

I was a bit concerned about a couple of points that wern't explained. One was how does the Prostate manage, is some reduced bloodflow left? What happens with all the material that dissapears? I just went in thinking - well no ones died from PAE yet!

I've had great result so far, now it's 2 months and prostate shrinkage is meant to mostly happen over 6 months. So hoping a TRUS scan then shows further improvement.

My prostate was 163ml - very large, people can have bad problems with much smaller sizes - from 40ml. The shape is a factor, an enlarged central lobe causes more problems as it presses on the urethra. This might influence the benefits PAE might bring.

I've read that some of the other treatments can't be done on a prostate that's over about 100ml, not sure why (removal of offcuts?) or which treatments but think TURP was mentioned. Over 100ml and you were maybe looking at more invasive methods.

Hope that covers what you wanted.

My prostate was 125grams when I had Thulium Laser surgery in England in 2013. In America it is a fairly new procedure but has been around here for quite a few years.

He complained about the size if mine by saying that I had given him a bad back as he had been crouched between my legs for so long.  

What about the much touted Avodart and Proscar?Is it still being prescribed by urologists or has it been abandoned as being ineffective? I asked my urologist to give it to me but he dismissed it suggested that i should have surgery... I am now on rapoflo which is mildly effective...

I believe you said that you had a turp eight years ago and it's no longer effective. Probably the prostate has grown back again. That's what they do..

There's no doubt in my mind what i would do in your case. I would research PAE as extensively as possible and if it lookded right I would have that done.  If I had any reservation whatsoever I would find the closest HOlep surgeon and have that done as i did in october and the result was unbelievable, just perfect. If you simply cannot have surgery then I would learn to self-cath, actually i would do that anyway, just in case. But there would be a Holep in my future eventually, without any reservation.

Don't expect your urologist to agree, he won't, as he doesn't do that procedure.

Best of luck but stay off the meds, that's my advice.

Ron  .