Prostate Artery Embolization (PAE)

Hard to say. Everything is probably very individual and depends on the skills of the  interventional radiologist. As a rule, it shouldn't influence any sphinkers functions negatively, once healed after the infarction.  In my case  it became unexpectedly better, mild incontinence after urination, which was persisting last 10 years and left underwear and pants with a wet spot, is gone now. Sexa and erections  became better and more controllable. I'm 70 years old, but feels again as 40. I think PAE is  amazing, when done right.     

Please send me the link.

Either through the forum or to my mail:

Thanks,

Yoav.

Please send me the link via PM.

Thanks

Kind regards,

Ben

Would you send me the links via PM.

thank you

Moderator comment: I have removed the link(s) directing to site(s) unsuitable for inclusion in the forums. If users want this information please use the Private Message service to request the details.

Sorry, the moderator doesn't allow to post links publically. Yo have to write to me privately or search yourself. There are many great sites explaining the advances in prostate embolization, including the new PerFection method of targeted embolization.  Results are pretty similar with slightly better outcome for PerFection.  

The only downside is quite high radiation exposure equal lifetime natural exposure. It might increase lifetime your probability of different cancers by 2-3%. Lifetime probability of getting any cancer is  currently 29% for man and 26% for women. 

I think that everybody who plans to undergo that experimental procedure should conducta a personal extensive Google search. It worked for me but I am taking some risks with high dose of X-ray exposure typical for any interventional radiology angiography and embolization.  Total exposure, including, preliminary angiography of the pelvic arteries can reach 120 mSv, or 40 years of average natural radiation exposure of  US resident.

Hi Gene,

    I tried googling PerFection and embolization, and I'm not getting any hits. I'd like to get more info on that so I will send you a PM.

    Re: radiation and PAE. Dr Bagla said they use a method that has only a relatively small amount of radiation. I can get you the precise details if you (or anyone else) is interested.

Rich

Hi Gene,

    My first reply got flagged by the moderator because I included a link to the manufacturer.

  Here's the reply again without the link but info on the manufacturer so you can google it if the moderator doesn't release my previous post. If you can't find it, let me know and I will PM you the link.

-----------------------------------------------------------

Here is my question to and the reply that I rec'd from Dr Bagla's office in Jan 2017:

  I know from a previous email that you said that the radiation involved for the procedure is less exposure than a typical CT-scan study. I'd be interested in knowing what modifications Dr. Bagla has developed (or uses) that allows for the reduced radiation. I assume that he uses some form of Fluoroscopy.

THE FLUOROSCOPY UNIT WE USE ALLOWS FOR REDUCED PATIENT DOSE.

HERE IS A LINK ABOUT OUR UNIT:

Philips USA: product HCNOCTN277  veradius-unity

Hi Gene, I see you are very knowledgeable about PAE.. I am happy the hear you had great results and I have not yet ruled it out.

My understanding, and I could be wrong, is that the PAE will likely need repeating at a later year just like a TURP. My friend had the original form of TURP 7 years ago. He said sexual performance increased after the procedure, he theorized that was due to the swollen prostate pressing on some key nerves, and his sexual functioned improved due to less pressure on the nerves running through the prostate (that is my friends opinion) His BPH has returned. He can't have another Turp because he recently had a pulmonary vein ablation to successfully relieve his AFIB. So within a week he will have the Rezum procedure performed as the sedation is not as heavy. I mentioned PAE, and like most guys they are afraid of PAE as their PCPS and urologists know very little about it and discourage them. Further more urologists will start to lose a lot of money if their patients go to an interventional radiologist for PAE instead of seeing them for one of the many channeling procedures. In spite of my earlier comments I still have an open mind and would consider it. But my cardiologist got visibly upset when I said I was considering it. He feared a PAE might cause a clot to be released that could cause a heart attack or stroke. While I admit I have not done that much research on PAE I have not read of any risk of blood clots . My cardiologist is rather old school and said the only time he would advise a patient to consider having a PAE is if a patient had bleeding from the Prostate, that needed stopping.. It is not that I am that scared of just PAE I am scared of any surgical intervention as my experience with a number of urologists has not been that favorable. I did see one interventional lradiologist in NY who said he had performed about 20 PAES, which does not sound like enough for my comfort. One question I think is a fair question. My understanding is that the radiation is fairly high, In the past I had had about 4 cat scans resulting in a lot of radiation exposure. I also had a stent placed in my RCA when I was 51. I am 66 now. I respect my cardiologist I have seen for about 30 years, Hey I'm 66 and generally quite healthy. Nevertheless, I feel had I known of the work of Dean Ornish and Caldwell Esselystein I would have not allowed them to place the stent and would have given more time to see if diet and exercise would resuce arteriosclerosis of my RCA. I have been on a plant based, whole food, non process no added oil diet for over two years. I lost 10 pounds have a lot of energy and generally feel very healthy. I look at NutritionFactss.org, and Dr. Greger pointed to a study (if I recall it was in China) where BPH was reversed on such a diet. Once again I feel I have an open mind. I have not at this point noticed a reduction of arteriosclerosis in the the penal arteries. With daily Cialis which helps BPH a little, Saw Palmetto and now Beta Sistosterol I feel I have somewhat less BPH, My urologist prescribes generic Viagra which I'm happy to say with the daily Cialist has resulted in a big improvement in sexual function. Sorry to give all this background but I will now get back to the subject . One urologists at Cornell said Bi Polar Turp or button Turp will not worsen ED and the chance of losing ejaculation is about 10 percent. Maybe he is particularly good at what he does but I doubt one would have such excellent results. Another highly recognized urologist I spoke said shame on that other doctor for recommending a bi polar turp as he said I did not need anything. So my trepidation with urologists is rather high as they all disagree what I need. For the most part they are very much against PAE which is natural as it is a threat to their income.. PAE seems promising to me as the interventional radiologist performing the procedure does not actually touch the Prostate or the nerves to the prostate. They of course have to be quite experienced to do this procedure. I'm glad your procedure was so successful My prostate is 40 grams and unfortunately my median lobe of my prostate has gone into my bladder making Urolift (which was my initial choice) about 80% as efficacious as it could have been had I not had the the median lobe problem, so it was discouraged. This urologist recommended either PAE, rezum or Bi Polar Turp. He is one of the few urologists who would even consider PAE, probably because his colleague in the same medical facility performs it. He said if he was my brother he would recommend the Bi Polar Turp. Another urologist said "he is not you brother" and frankly you do not need any procedure. My uro-dynamics test indicates I have an overactive bladder. A cystoscopy of my bladder shows lines indicating pressure on the bladder but the urologist who did that test did not feel there was a need for any aggressive surgery at this point. But a point you will probably agree with, in another 5 or 10 years if my bladder gets so stretched out from the urine pressure I might become one of those men who have to self catheterize. So I am aware of the dangers of waiting too long. Sorry to be so long winded. to tell the truth the entire BPH issue was so unsettling I definitely decr

eased my focus on this problem. The only reason I jumped back into the discussion is that someone from Prostate. NET wished to know my experience with PAE.

I’ve done a lot of research regarding BPH. In some cases the treatment is worst than the disease. I read words like “Game Changer”, “Gold Standard”. I’m not a doctor nor am I qualified to give medical advice. I can only share my opinions based on my own personal experiences and research. Based on the information you provided. I would caution going against your cardiologist advise. Your cardiologist may not be knowledgeable about PAE. He’s not alone. Many urologist aren’t either. PAE has only been recently approved in the United States. There are several doctors who perform this procedure. I would recommend you consult with a doctor who specializes in PAE in your area. Hackensack Hospital, Columbia, Cornell and Mount Sinai are a few locations who maybe able consult with your doctor to determine if PAE is right for you?

My urologist recommended PAE based on my BPH. We discussed TURP, Greenlight Laser, Rezum and UROLIFT. Unfortunately there aren’t many doctors who perform this procedure. I think experience and training is just as important as the procedure and would recommend you find someone who is Board Certified in Diagnostic Radiology, Interventional Radiology & Vascular Radiology.

I haven’t found a once and done procedure for BPH.

Good Luck!

Robert

Thanks Robert,

At Mount Sinai , Aaron Fischman MD interventional radiologist performs prostate artery embolization. As of last January he said he had performed about 50 such procedures.

At Weil -Cornell Tim McClure interventional radiolgoist with heavy background in urology as of last January said he had perform around 20 such procedures. Not many reviews online but his patients love him. I met him he is very smart yet humble and I would think this would be a good choice for me, but I was concerned he needed to have more PAES under his belt.

Raj AyyagariMD at Yale in New Haven Ct said as of last january he had performed about 100 of these procedures/ . This is what he says on his web page "The procedure does not yet have as a long a track record as surgical procedures such as the TURP. However many large-scale studies have proven that PAE is safe and effective, and this procedure has been done in the USA for several years with great results. In partnering with a few prominent Urologists in southern Connecticut, I have done more of these procedures than anyone else in the northeastern United States. All patients who are considered for this procedure also get a full evaluation by a Urologist, so they can understand all their options and choose what is right for them.

Hackensack UMC John S DeMeritt MD, interventional radiolggist performs this procedure.

I hear reviews of Doctors who perform his procedure in Miami, Virginia and the West Coast, I don't recall reading even one review of interventional radiologists in the Northeast particularly in NYC who perform this procedure. I would like to hear from Prostate .Net subscribers who have used any of the four doctors listed above. Please tell us which doctor you used, the results and how pleased you were at the procedure and how long it is likely to last. Thank you

I have a question for subscribers on Prostate. net who have had or are thinking of having a PAE. My prostate is 40 grams, I have an overactive bladder and I have medium lobe intrusion of my prostate into my bladder. Am I a candidate for this procedure and if so which of the above doctors would you most recommend?

Personally speaking. There are only 3 doctors I would be comfortable with based on my own research regarding PAE.

Dr. Francisco Cesar Carnevale

Dr. Martins Pisco

Dr. Shivank Bhatia

Unfortunately there are no long term studies on this procedure. Dr. James Spies has performed extensive research in the field of Uterine Fibroid Embolization and I believe was the first FDA clinical trial approved for PAE. I don’t know how many PAE procedures Dr. Spies has performed so I wouldn’t add him to my short list.

PAE generally is recommended for prostate less than 50g or median lobe greater than 3cm just to name a few.

Wishing you good health!

Robert

CORRECTION: PAE generally is not recommended for for prostate less than 50g or median lobe greater than 3cm just to name a few.

Hi Robert, neither of us are doctors yet you have done quite some research. while I like to make up my own mind, I appreciate the information provided to me at this site by knowledgeable independent thinkers like yourself, who are flexible in the treatment of this conditon. So to repeat what you said, to ensure I got it right if my prostate is at 40 grams and I have medium lobe entrance into bladder, and I have an overactive bladder, I do not appear to be a good candidate for PAE.

I'm not a good candidate for urolift as well. due to the median lobe. That leaves me with one of the channeling procedures done by urologists. Bi-polar Turp, highly recommended by one urologist, will likely cure the BPH. But the odds of losing the ability to ejaculate increase, and there is always the possibility of incontinence, erectile dysfunction, and a host of other problems. I will not go into that procedure lightly.

I tried Tamuolsin but stopped due to terrible dizziness. too bad as Tamuolsin is generic. The urologist who proscribed Tamuolsin immediately placed me on Rapflo which is expensive and not generic. I have a pretty good prescription coverage, but from what I read it diminishes ones ability to orgasm. I already have a problem delayed orgasm which I do not wish to worsen taking Rapaflo. So the only things I take are daily Cialis ( only affordable due to a decent prescription plan) with basically no side effects. However I have an easier time with sex if I add 25mg to 100 mg of generic Viagra prescribed by my urologist. I have had an improvement of BPH and sexual function to a small degree with generic Cialis. The good thing (for me) is that I do not notice side affects . Adding genric Viagra and my sexual function has greatly improved. However I am 66 and not 22. So I can't have sex 3 times in a row the same day like I did when I was 22. I really enjoy sex with my wife even though the times per week are much less. I really don't want to give that up. It is not just the orgasm release of stress it helps with intimacy,

It sounds almost as it I am doing great. The problem is I have almost no idea how often I will have to urinate. There are times I can drive 30 minutes to the gym and can delay urinating. I wake up at least once every 2 hours, so I do not get a solid nights sleep which is not healthy. However, sometimes I have to go so bad I am embarrassed to say I sometimes have accidents. Also sometimes there is such a delay to urinate such as when you are seeing a Broadway show when waiting to urinate creates a lot of pressure on the bladder.

So to sum up what I do is manage my condition, but in no way is it cured. What about those who chose Rezum or other steam channeling procedure vs other channeling procedures. . What have been your results?

Thanks for listening Robert and the other members on this site who have read my rather long discourse on the subject. It is hard getting older. Not only BPH but worse yet is the chance of prostate cancer. I usually don't worry, by taking one day at a time. At the present time my management of my situation is probably the best I can do. I am also on a whole food, plant based diet, with no extra oil, which lessons the incidence of inflmation, that aggravate BPH or increases the odds o prostate cancer.

For those seeking to treat or try to prevent prostate cancer I would look at the work of Dean Ornish MD, who is one of the doctors I follow who recommend a plant based diet. But this is not a panacea either. For the last two days I have had the worse sore throat, cold, cough and back pain I can recall. I thought the plant based diet would prevent colds. Sometimes it seems to do that, but it is hard to really know.

So my final thought is a repetition of what I said earlier. I don't think there is a panacea to treat BPH, at least I have not found it yet, for a lot of us guys. If you have found the one treatment that cures BPH and preserves and improves sexual function, without stopping your ability to ejaculate, without incontinence, than God Bless you. Honestly, you are most fortunate. However it seems for me and a lot of guys on this site, managing BPH without jumping into a procedure that can permanently cause sex problems and or incontinence is a fair way to approach this subject. However, your urologist should monitor your bladder and prostate. At a certain point the progression of BPH can damage your bladder. so keep and open mind, have a competent urologist who does not try to rush you into a surgical procedure unless absolutely needed is for me the way to go, who you TRUST, and looks out for your interests, not just to make a buck is very comforting.

As I mentioned my urologist recommended PAE. His second recommendation was the Bi-polar TURP. I believe he called it a button TURP. When I looked further into this procedure, surgical skill, experience and outcome warranted further investigation. If I was going to have The TURP procedure I wouldn’t use my own urologist based on his lack of experience and surgical outcomes. I believed his education, experience along with No malpractice lawsuits he was qualified to diagnose and recommend treatment options. Dr. David Samadi and Dr. Eastman are both highly skilled surgeons. I suspect they would recommend the best course of treatment. I sometimes wonder if doctors favor one treatment over another based on a patients diagnosis or their own skill and treatment preferences? Perhaps a little of both?

BPH isn’t for everyone. Some doctors have treated patients with a variety of prostate sizes and median lobes only to have minimal symptoms improvement.

I won’t recommend any one doctor or procedure to anyone. I would recommend further investigation until you are comfortable you made the best choice based on your own medical history. What’s right for you is more important then what is right for me.

It’s been a pleasure.

Thank you!

All the best!

Robert