Prednisone after PAE

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Undergoing preliminary consults at Inova for PAE procedure.  Was told I would be on Prednisone following surgery.  Problem - I can not and will not take the prednisone regime of building up dosage and tapering down.  I did this about 5 years ago for another problem  and had EXTREME anxiety for over three weeks.  I did not think I was ever gong to be normal again.  It is NOT an uncommon problem.  What did the rest of you take post procedure??  Surely there must be something other than prednisone.  If I just have to take the prednisone, I will not go through with the procedure.

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  • Posted

    I took Prednisone (along with other meds) post-PAE. Is the dosage they are recommending the same as what you took 5 years ago? Did you ask them if there is an alternative?
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  • Posted

    I would reconsider PAE, it works sometimes for some people but there is a high rate of failure and some risks. The first time I did it they did not give me prednisone, it hurt like hell and burnt for about a week but it IS possible. I had a second PAE and they gave me prednisone because I requested it, that time it was easier but PAE did absolutely nothing for me - I read some medical journal online that says there is an 18% failure rate - you can google it for yourself. Had I known what I know now about PAE I would have stayed away from it.
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    • Posted

      The way I understand it is that if it does not work then the other procedures can be tried.  On the 2nd of this month, I had a procedure at VA where they went up into my urinary bladder and laser busted up TEN bladder stones that were as big as 2 cm.  They were causing me to have hematuria.  It is not fun peeing blood at least once a week.  From what I read, this is probably the result of my BPH and incomplete voiding of the bladder and hence the formation of stones from the concentrated urine.  The VA does not do PAE but the "other gold standard" sounds not too great either and that is what they offer.

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    • Posted

      I did do another procedure, FLA and I believe the delay having a good procedure and extra stress to my bladder from PAE (because the first week or so it's almost impossible to pee) made the procedure not as effective as it would have been. If you are getting it for free I suppose it's not a big risk, though like I wrote before there have been reports of damage when the material they inject does not go to the target. I don't understand why they don't recommend wearing a Foley catheter the first week after PAE, apart from maybe they are not Urologists and don't know how to help with that. If you can afford it FLA is the way to go I believe, or maybe Rezum which is more affordable and has less sexual side effects than TURP.

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    • Posted

      My experience with and understanding about PAE is very different from Mike's. There are risks with every procedure, and depending on your condition, there are risks with doing nothing. I was able to pee right after my PAE, though it did burn when I peed for about two days. Re: the microbeads ending up where you wouldn't want them, be sure (as with any procedure) to choose an IR or urodoc who has done many, many of the procedures that you will be having. Be sure to research all options, as they all have pros and cons. If you are considering PAE, I believe the most experienced IR's in the US are Dr Bagla in VA and Dr Issacson in NC.

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    • Posted

      Rich, I know PAE works for some, I spoke to someone in person who had it done by the same Docs who did me, he was only the 6th patient and had perfect astounding results. That was the reason I took the chance on something new.

      Here is some info I gleaned from a medical abstract which had I read before my PAE(s) would have pushed me away. Basically it's pointing out besides the risks that after 3 years it is 64% less effective, if I am reading it correctly. This makes sense as the body has the ability to re-route blood supply. I suppose with any of the traditional surgeries the prostate can grow back, but probably not as fast as blood supply.

      See below - if you search on internet for 'Minimally invasive surgical therapies for benign prostatic hypertrophy' you will find the whole article which is quite interesting reviewing some other procedures.

      ****

      Contemporary literature highlights considerable failure rates as high as 19% with 15% of patients requiring TURP within the 1st year after treatment. Uptake may have been limited due to these factors and availability of specialist interventional radiologists required to perform the procedure. However, increasing experience with PAE has led to improved procedural success rates. PAE has gained interest recently with further studies showing acceptable outcomes in IPSS scores at 24-months' postintervention. Despite this, TURP results in significantly better (P = 0.029) outcomes in IPSS scores and quality of life scores at 1-months' and 3-months' postprocedure.38 Another large prospective series by Pisco et al reported a 63% reduction in IPSS at 36-months' follow-up with PAE.Complications of PAE are not insignificant and include failure of the procedure, dysuria, hematuria, hematospermia, rectal bleeding, and urinary retention. Although rare, risks of inadvertent embolization and untargeted ischemia of the bladder, corpus cavernosum, or anus do exist and pose a significant compromise to patient outcomes. A recent meta-analysis identified six cases of bladder ischemia. More long-term data is necessary to define the safety and feasibility of PAE.

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    • Posted

      Mike,

         Interesting article. I didn't see where you saw 64% less effective after 3 years. The closest text that you might have been referring to says a "63% reduction in IPSS at 36-months' follow-up with PAE" which is actually the opposite of reduced effectiveness. A reduction in IPSS scores means alleviation of LUTS symptoms, which is what we are hoping for.

      Rich

       

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  • Posted

    Hey buddy I would have to agree with Mike. If you can not tolerate Prednisone, DO NOT have the PAE . 

    If I had not had the prednisone, for several weeks after my PAE procedure, there is no way I would have been able to empty at all. 

    Not to mention my procedure was a complete failure. My prostate is exactly the same size as it was before the procedure after 6 months. Total wate of money for me. But seriously you need the prdnisone, and antibiotics.

    Considering FLA here, just wish insurance would cover it.

    Good luck

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    • Posted

      Joe, in regard to insurance on FLA. I do not know the particulars, but I understand that some of the private insurance companies like blue cross blue shield are paying a percentage of the cost now. I believe it may have been Jim that possible got it approved but Dr. Karamanian should be able to tell you. I am recieving a percentage back from Medicare on my FLA procedure. As I understand it is all in the codes used during the filing. Your doctor can give ou those.  I know that the clinical trial is still going on but if you had PAE previously that would eliminate you from the trial. 

      But I Did pay full for mine and it has been a total success for me. Well worth the debt I incurred. But I am pleased I will get some of that money back. 

      As someone else said, it is truly a product of picking the right practitioner as that is the key to success because this procedure is an art as much as a science. FLA is very accurate and very controlled in the tissue removal where PAE is totally random in tissue removal. It has worked well for a lot of the men on this site. I know currently of no failures. 

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    • Posted

      Hello again J, I think we talked before, under another topic. I have talked a couple times with DR K and his staff, and needless to say they are amazing people to deal with. I sent them all of my insurance information, which is BCBS for the state of TN. Unfortunately Dr K says they do not have a billing office, so therefore will not seek a prior authorization from my insurance. Ravina did send me all of the CPT codes, and I have checked with the insurance, and all are approved and covered. However they will not give a prior approval, without a request from the provider. I am going to try and speak with a supervisor tomorrow and see if there may be someway to by pass that requirement. I will pay for it out of pocket if I have to but dang it would be nice to get them to start covering it.

      Its funny I was the first patient ever that got approved for PAE thru BCBS at UNC. Perhaps I can get luck again lol.

      Thanks again for the info.

      Joe

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    • Posted

      Joe,

      Sorry the procedure didn't work for you. I am now 10 days post PAE and have been able to control the side effects (prostate swelling) with Flomax and a minor amount of Tylenol and Ibuprofen. Kaiser did the operation and I only had to pay a $250 copay. In the past few days I have not even had to take the Tylenol and Ibuprofen as the swelling is going down. 

      Why be concerned with prednisone when Flowmax works just as well (at least it does for me).

      Tom

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  • Posted

    vigneron, 

    i would say that if you cannot use the Prednisone then you will have to have an extended foley cath in the PAE procedure. Another possible and  helpful anti inflammatory is Aleve 220 mg twice a day. I did use this.

    I did not do PAE even though I did go visit the two most experience doctors in that field. I instead chose FLA and that choice was a blessing for me. I did not do the prednisone dose as the later men did when they should have and I think it would have helped me but I don't like what steroids can to to an immune system so I was fine in the FLA as you wear a foley cath for at least a week anyway. With FLA you will have the foley cath for at least 7 days anyway and it was not that bad for me. 

    Good  luck In your choice and if you need any more detail information, feel free to personal message me by using the "envelope icon" above and next to my name in this message and we can then communicate. I will tell you what I know about both PAE and FLA. 

    john

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  • Posted

    Talk to the Dr about taking ibruprophen ( Motrin). They are giving you the prednisone to decrease the inflammation in your prostate. The Motrin will do much the same thing without any anxiety .

    Neal

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