Post-PAE MRI Shows "7m abnormal signal"

With HOLEP they biopsy tissue  that is removed

Thanks Tom. How are you now? What types of treatments did you have to undergo treat the lesions?

One remark on my MRI report today was that the lymph nodes looked ok. Is that a good sign?

Thanks again.

Neil

Neil,

The lymph node report is great news. If you only have one small area of a possible 7mm tumor than this is a very small amount of prostate cancer and should be easily treatable. 

I had a number of little tumors in several parts of the prostate, Gleason grade 6 - so very low risk. However, due to the number of positive cores and percent of cancer in each core, I decided to move forward with treatment after a year and a half of active surveillance. 

I interviewed many doctors - each one did a different type of treatment. I decided to go with HDR Brachytherapy - high dose rate radiation. I had two sessions, spaced two weeks apart. This was in Sept. 2014. The only after effect was tissue swelling after the second treatment and as a result I had to have a Foley catheter for 5 weeks until the swelling went down and I was able to urinate on my own again. This happens in about 10% of patients - I have an enlarged median lobe that became swollen and cut off urine flow. 

My PSA is now down to 0.1 and I could not be more pleased with my decision to move forward with the radiation. I have a friend who had his prostate removed at exactly the same time as I had my HDR, and he is still having issues controlling his urine.

NOT being treated and being biopsied and MRId over and over again is much worse than just being treated. Now, I have peace of mind - a tremendous relief from the constant concerns I had before my procedure. No more poking and scanning and reports and anxiety. Just a quarterly (soon to be semi-annual) PSA test.  

Hope this answers your questions,

Tom

Thanks Tom - that is very helpful - I never heard of such a treatment. I don't have a median lobe but just lots of inflamed transitional zone tissue. So I guess that would get more inflamed but maybe steroids like prednisone would keep it down. Anyway, thanks to jimjames I have learned to self-cath so maybe I could avoid the Foley.

What part of the country do you live in? I am near Detroit. Was the procedure done by a urologist or IR?

Thanks for helping me and I wish you all the best. Neil

Neil,

Earlier this evening I asked Dr. Moon about the procedure Tom is talking about. (see link below) Don't know enough about the procedure to know if Dr. Moon is correct, but I will say that it's been very hard to find much info about the procedure. Been around for more time than Rezum but only one doctor seems to be doing it, and haven't heard anyone here report they have had it -- all of which gives some pause. 

https://patient.info/forums/discuss/rezum-have-you-had-this-done--499675?page=3#2403690

Jim

Neil,

HDR Brachytherapy is performed by a urologist. There are two types of Brachytherapy. The first, and by far most common, is low dose radioactive seed placements into the prostate. This is done in one session and the seeds are left in forever. They are radioactive for a short time then become inert. The second type is HDR - high dose rate. I had two sessions. The prostate is radiated with little catheters placed into the prostate then removed, so nothing is left in, and there is no radiation penetrating external tissue as is the case in normal external beam radiation, so there is much less damage to the bladder and rectum. The cure rates for HDR are the highest you can find for any prostate cancer procedure. It is a specialty, so not easy to find a doctor who does this. Before deciding on treatment for my prostate I interviewed several urologists, each one performed a different treatment, and after a year of research decided to go with HDR. I am 100% happy with my decision. 

As far as the median lobe is concerned, it's part of the prostate so you have one, but in my case it was enlarged and interfering with urine flow. Not only are prostates different sizes, but the different lobes can effect urine flow. An enlarged median lobe can be particularly irritating as it can push into the bladder or squeeze the urethra and reduce urine flow even in a prostate that is not particularly large. 

Hope this helps,

Tom

Thanks Tom - that really helps my understanding of the procedures available to me.

All the best

Neil

Thanks so much for this information j12080. This is all new to me and my head is swimming. I thought I was an "expert"on BPH and now I am a novice again. I have printed out your note here.

One question I have: Did you consult at all with any urologists or are you working exclusively with IRs?

Also did you ever have previous TRUS guided needle biopsies and if so did the scars show up in the MRI?

I wish you all the best too and thanks for your kind words. Neil

Neil. Yes, I went to 3 Uros prior to finding out about IRs. All did a DRE and told me it was soft tissue and was slightly swollen with a PSA of 4.2. All wanted and pushed hard to do a 12 needle blind biopsy. I said no and found an IR who did a 3TMRI with a pelvic coil not a rectal. After he read it I sent it to a IR who did focal laser ablation of PCa as I, like you, was concerned first that I had cancer. I then found out this IR agreed with the IR who did the MRI, that I did not currently have PCa. But the Uros totally missed it. My PSA was high because of the size of the prostate and not only slightly swollen. It was very large and therefore a high PSA number but no cancer. Still I had BPH so I changed direction and stopped worrying about PCa. Then with research I found PAE and the possible help from FLA. FLA fits me now as I can get rid of the dark spot I told you about and get it removed and reduce the tissue blocking the urethra at the same time with no sexual side effects and it is a quick recovery and results are faster than waiting on PAE shrinkage. Cath is about the same time for either. Cost does not matter, only results. I will borrow the money to get my life back.

Please keep me posted as to your journey and if I can help with any other comments.

Hi j,

 

Please ignore the empty message !!! Here's what I had meant to put in it. I have a couple of questions/comments for you. Do you know if a 3T MRI of the prostate would always show what area of the prostate was causing BPH symptoms? And there are some docs who do not cath before or after a PAE. Is there cath with FLA?  Thanks!

 

Hey richp21, good to hear from you. I only know that I have had two 3TMRIs, one in October of 2015 and one in October of 2016. These were two different Hospitals two different IRs. Yes, both showed the pinched area. Both the doctor show the area of the prostate tissue that had multiplied and cause my prostate to be 125 cc. He also showed me on the MRI my seminal vesicals which he would make sure these where not vaporized by the laser. thereby I would not have retrograde ejaculation issue after the focal laser ablation procedure. He showed me where the Nerve Inferior hypogastric plexus in the peripheral zone which controls the erection. He explained how the focal abalation would be no where close to this area. He show me the entire length of the urethra and where it was pinched and narrow at the top in the medial zone. He also showed me the dark spot where that was not cancer but that we could remove when doing the removal of the tissue around the urethra. He diagramed how he would debunk the tissue that was pinching the urin off. He showed me the bladder wall and how as of NOW, I do not have tribeculation or damage of the bladder wall. He does this at his center in Houston which is for prostate cancer. They noticed in this procedure that BPH symptoms dramatically improved when doing this for PCa. So they can target now for BPH and get specific results. First if the IR is good At his job then yes, your MRI should show this ever time. Cath is detrimine on a case by case issue. I have been to Bagala and to isaacson's offices both told me I would have a cath for 2 to 5 days because my prostate is so large. Walser, Karamanin, and Sperling I also went to see and they are FLA docs each said the same again cause of the size. 

I can can give you the name and contact of the great doctor who did the great job of explaining my MRI to my. You can contact him and he will have you upload your cd MRI through a portal on his web site that is set up just for that. You just put it in the drive and hit the button. AND he will review it with you or anyone with no charge or commitment from you. He is a wonderful doctor and I know it's hard to believe. But, he did it with me and told me he set up the portal to help anyone gain knowledge of their situation without charging them. 

If if you or anyone wants his contact you have to personal message me so it is not blocked on this site and I can tell you why that is but it is that way. Just pm me and I will give it to anyone. I still have not made my choice of Doctor or of weather I am going PAE or FLA. But this site has been a wonderful blessing all of you guys are a blessing in a scared world. I have to go now and take my wife to a movie. I will answer all pm when I get back. Duty calls.

 

 

I replied to you but it is in review. If you don't get soon, we will pm.

Wow, thanks for your incedibly thorough message. That doc sounds amazing. Was it Dr Walser by any chance? I will pm you to get the info as I am definitely interested in contacting him/her.

Hi j12080,

Forgive the duplication from another recent post on FLA in another thread but you have mentioned other doctors than Sperling now offering the FLA. Do they offer it for BPH or only for prostate cancer removal?

As stated in my other post, the concern about FLA for BPH is that while I understand the promising back story of bph improvement after FLA for prostate cancer, it seems mostly anecdotal and second hand at that from only one doctor (Sperling) athough you mention a couple of others.  Is there any published literature on this? Peer reviewed studies in the journals? The only information I could find was on Dr. Sperling's website who appears to be the only doctor doing the procedure.

I also asked Dr. Moon about FLA in another thread (link below) and he basically said it was just another thermotherapy like TUNA. TUNA also was promising at one point, but fizzled out when peer reviewed studies showed that the results were just not there and/or very durable.  

https://patient.info/forums/discuss/rezum-have-you-had-this-done--499675?page=3#2403690

Jim

Some men have very large prostates, and some others are cathing or on a full time catheter. Those men will probably need a catheter after a PAE. Most men will not need a catheter with Dr. Isaacson. I have had 2 with him, and have not had a catheter with either. I'm not sure about Dr. Bagla. The prudent thing would be to discuss this with any IR you are evaluating to do your PAE.

Neal

Hi Jim,

If you google "aetna + focal laser ablation for the treatment of prostate cancer", you can look at the aetna resource on this procedure. I find Aetna an invaluable resource for the current status on any procedure. They discuss if the procedure is currently experimental or approved by the FDA and then go into good detail about the technical description with most current research cited that you can then follow up on PubMed.

Being an insurance company they have to do their due diligence. You can just google "aetna + whatever procedure you are interested in" and will get a good starting point for your investigation.

Neil 

Jim, yes I have vistied with him in Florida.  I also have visted with two other Doctors that do FLA and yes it is for Cancer. They are sure as with Rezem they can produce the same debunking results and have done so in the treatment of PCa. The key I like is that the tissue removal is exact and very targeted and they don't invade the urethra to do so. And I like that this is not a Uro doing the work. I have never had a positive situation with a Uro.

The laser is very small, and can remove the tissue that is pinching the urethra. Infact I had one of these Doctors consult with me at no charge and he diagramed where and how he could do this with no side effects on the sexual side and showed me why it would be that way. It seems like the best treatment. It basically does what Rezum does but is more accurate as it is using a real time 3TMRI view and not going up the ureatra and then punching through it to debunk the tissue as in Rezum. I am sure Rezum will also work and they really do the same thing.

I will send you a Personal Message with the names and the contact numbers of the other doctors either tomorrow or Saturday. One of them will charge you nothing to look at any MRI you have and consultation with you.

The guy you mentioned, when I went to him, he charged me $250 cash and spent about 45 minutes with me and my wife.

This doc I will give you the name of was 3 hours with us and said No charge for consultaions and no pressure. Really good Doctor but I will give you all that this weekend and you can make you own contact. I still have not made up my mind what I am going to do. But I have to do this pretty soon. 

Good luck, as I told our friend Neil, all the guys on this thread are in the same boat and we need to all crab an oar and work together. This disease needs a cure.

J12080 and Neil,

I'm just trying to point out that regardless of the logic behind FLA for BPH, or how convincing and generous the doctors may be with their time, I still haven't seen the peer review studies behind it as we do with PAE, Urolift and REZUM. It seems there are just a handful of doctors that perform it, and they alone seem to be the source of the anecdotal information which is an inherent bias. I used the example of TUNA before, as Dr. Moon just the other day here noted the similarities of the two procedures. There was a lot of excitement about TUNA in the beginning as well but now we don't hear much about it because it turned out not to work very well. 

Neil, thanks for the Aetna link, but there's a difference between the efficacy of FLA for tumor removal and to alleviate BPH symptons. 

Don't mean to sound negative and I really hope this is one of the breakthrough procedures so many of us are looking for, but I think it prudent to raise these questions with so little objective information currently about this procedure. Good luck if you go through with it and please report back. 

Jim

Jim you are correct and it is all politics. Uro lobby pressure holds back interventional radiation treatment. They stop efficacy studies when a uro can't preform it. And Equipment maufacturers who put up the clinical trial money for expensive MRI technology see the market in neurological and cancer abalation not BPH. They are wrong in my opinion as the BPH market is so large. But this technology is very expensive with 3 T MRI machines costing between 2 and 3 million and the lasers used are a one shot product meaning one patient and it is disposed of. They have a cost to the doctor of $5,000 each. Visualase lasers are the leader in guided laser ablation products and that is what they are charging and neural is the direction they want to sell in. These FLA doctors have simply recognized the dramatic improvement in BPH symptoms and the process leaves the same result of tissue debunking as Rezum.

Bottom line it is hard at this time to get trial money committed for this little old BPH problem. Add the uro political pressure, which is a much bigger, powerful association and we will be waiting a long time as each of these uro solutions want a "lick of the salt block". For those that do not understand that statement, a "bite of the Apple". Come on they don't care about us. How could they if the uro industry still calls the barbaric TURP procedure the gold standard in BPH treatment?

I got to go to bed, I am old. I will send you the contact info tomorrow as your addition research will help me as well as all the others. We have to turn over every stone together. I agree with your points and I have asked why is it this way. 

Thank you you for the points you are making. I have been dealing with these question for a while. They do not make this easy but I have to find the correct answer. As I have said before, I have not made up my mind yet

Thanks Jim. I was only providing the Aetna link for FLA w.r.t. tumor removal which sadly is now my new focus. My BPH will have to take a back seat for a while but CIC will bide me time.

Neil

Hi Neil,

Thanks for the clarification and I will go take a look at the link. I haven't had the need to research out prostate cancer, but at one point I was concerned I might have bladder cancer and sought out other discussion groups more focused on that which is something you might consider if you aren't already doing it. 

Jim

Jim

Forgot to mention that if you google "Aetna + BPH", you will a great up-to-date technical summary of all - and I mean all - treatments currently available for BPH including approved ones, experiemntal ones and weird ones. Are procedures are well-referenced with current studies and papers. It makes for fascinating reading and is a good place to start. Of course there is no mention of CIC as a treatment for BPH.

Neil - I urge you to be careful with treating this. There are ways to score the agressiveness of a tumor and 95% of them will never cause you a problem. Other than ciber knife ALL treatments have a very high side effect profile, The biggest one being impotence, which depending on your age and the treatment, runs from quite possible (30% and up for radiation) and probably (prostate removal). And under the best of circumstances, you'll need a pill for the rest of your life.

By all means, if its determined that you definitely have cancer and it could be life threatening, do what you need to do. But with some testing, you can narrow your odds down and in the vast majority of cases the chances of it evey bothering you on any level is in the 1% range. Keeping an eye on it and doing something if it starts to grow is most often, the most prudent thing to do. Those Urologists, you know, the ones who recommend TURP, leave you with a foley indefinitely, etc. will hit you with "most men just want to get it out" and they'll tell you that prostate removal is the "gold standard" - and where have we heard that before?

All of those doctors can get it up, don't need pads and never walked around for a day, much less months with a rubber hose inside them hooked to a bag on their leg. 

Just another viewpoint you won't get from any doctor who hopes to sell you a treatment...

Thanks oldbuzzard - I understand what you are saying here. I am thinking of just redoing the two liquid biopsies I did a year ago which detect any cancer cells at the molecular level. Last year's tests were perfectly clear.

Neil

Dr Bagla's brochure says "No need for Foley catheter". Could another kind be used?

That probably means no need for any kind of catheter.

Thanks for the excellent explanation. Am interested on your Doc in Houston but not sure how to contact you via pm. Any help appreciated. Best.

Hi Jim,

I was thinking about all this today and how I was getting comfortable with self-cathing and looking forward to getting back to my research and forgetting about BPH procedures for a few years. Then I thought that in light of my recent setback all of us who do self-cathing for our BPH should also be sure to not foget to get checked for prostae cancer once a year at least. After all the prostate is still growing and their are many reports out there that believe BPH is a "pre-malignant" state which eventually will evolve into PCa due to oxidative stress and other factors.

So while you have done us all a hge service by showing how we can avoid the uro's knife we should still remain vigilent about the possibility of PCa. This can just involve following our PSA trends (note: "trends" and not absolute values since that depends on size). Also we can try liquid biopsies, like apifiny and mips is easily available, or PCA3 which is a step up from PSA. Also the 3T-MRI machines can now detect PCa ( thanks a bunch ). But please avoid TRUS - needle biopsies unless absolutely necessary. I believe the first one I had in 1996 actually gave me BPH through an acute prostate infection and subsequent ones caused put me into AUR due to tissue blocking the tip of my penis that hyper-extended my bladder causing ischemia/reperfusion damage to my bladder wall.

Anway, just a random thought.

Neil