Prostatic Artery Embolization procedure

No,  not sure.  Typically, it is the transition zone where the hyperplasia occurs that leads to LUTS. It forms roughly the shape of an innermost circle around much of the urethra. Around it is the central zone, then the periphery. Histologically, there isn't much difference between the zones, or lobes.

Let us know what the doctor said, its a learning curve for all of us.

Didn't your cystoscopy give you an idnication of the cause of your obstruction? The urologist who did my transurethral U/S had told me I had large median lobe that was obstructing my bladder outlet but I found that curious as prednisone (taken for asthma a few times ) would totally clear up my BPH symptons for a week or so. So I had another uro do a cystoscopy (which I watched realtime) and in fact I had no indication of  a median lobe at all - just a very long hyperplasia in the transitional zone clamping down on my urethra.

Do you have a theory for the cause of your obstruction? Did you have an MRI to get a better visualization of the pathophysiology of your prostate perhasp along with a TRUS for a true 3D dynamic scan? Did you ever self-cath?

I had to cancel my trip today due to illness overnite and have rescheduled the scan for 2 weeks from now. I had talked with Dr.Isaacson about embolizing down into the transitional zone where the BPH resides, as you describe but he said he prefers to stay clear of that region because of the dangers of embolizing the urethra. Perhaps with large prostates that could be why the PAE is less effective or takes longer? All the best. Neil

What the urologist said was that I had the classic signs of obstructive urinary flow due to BPH. You have an anatomical variation that may explain your lack of success, I don't know, but it will be interesting to see what Dr. Isaacson tells you.

By the way, for those who want to know early on with more precision how they will fare after a PAE, there is a research article I ran across that said that an MRI taken 30 post-procedure of the prostate can give a good clue as to success in the future. It said the amount of necrotic tissue (more is better) seemed to be a good indicator of success.

Also, for those that are contemplating PAE, since it seems that tissue changes rather than size reduction account for almost all of the benefit, similar to taking an alpha inhibitor, I wonder if those that have had good success with them are more likely to do well with a PAE.

It would be a very good paper for some to write. A retrospective study, if that information is available. There is still a lot that is not know about why the PAE works. It's not about the size: I mentioned in another post that in 3 years time, the prostate is almost the same size as before, but the benefits don't change much, at least according to research so far.

Thanks 333health for your response. I don't know if you noticed but I started another thread recently on PAE failures titles "PAE Disappointment Journal". The idea is to compile experiences of "failled" PAE procedures and look for trends as you discuss here. So far the response had been very good.

I myself have been on alpha-blockers (Xatral) for over 10 years and it has been extremely effective (much more so than the 5-aplha reducatse inhibitors). All signs pointed to me being an ideal candidate for PAE but now at over 5 weeks my BPH continues to worsen.

I wonder if it could be related to size? I am trying to get statisitcs on PAE qualitative score measures vs initial prostate size. Also could the TRA vs the TFA entry be a factor in the outcomes? I wrote Dr. Isaacson about this.

Have you yourself ever tried as an experiment taking a steroidal anti-inflammatory to see how it affects yours BPH symptoms? I had some prednisone (50mg) tablets left over form last's asthma bout and tried as an experiment taking just one tablet and then getting my PSA measured. Three days after taking the pill my BPH symptoms disappeared totally and PSA had dropped from 10.5 to 0.5!! But a week later I was back dribbling again. Also steroirds are very dangerous but as a scientist I could not resist doing this experiment to confirm that my problems are all autoimmune/inflammatory related.

Have you been screened for PCa? I did two liquid biopsies last year (Apifiny and MiPS) which are easy and cheap and I recommend them to all here.

All the best and thanks for your response. Neil

If the prostate's size is not reduced, it seems its pressure on the urethra would continue and, thus, you would still have trouble voiding, ie. totally empting your bladder which causes more frequent attempts to void...

Thd TURP is just "one procedure" for prostate problems while there are "many", ie. 20+. Their success depends on your doctor's experience performing them successfully, as well as, the specific type of treatment being appropriate for your "individual" prostate problems...I and many others on this forum have chosen not to do the TURP, because "too many patients" confirm "too many" complications and side effects, some of which are irreversible...My first URO DOC could only offer a TURP so I chose a URO DOC that was recommended to me that offered non-invasive alterative prostate treatments and had a long history of success. He ran a Lot of Tests and determined the REZUM was the Best Treatment for My Specific Condition which, even Dr. Isaacson agreed with (PAE Specialist)...Thus, I feel like the REZUM offered me the best chance of success.....We'll soon know when we try a TRIAL VOID next week and repeat it if necessary until the bladder-prostate perform as they should...At least I'm not experiencing Any Negative Complications nor Pain, at this time, due to the REZUM....I hope my TRIAL VOID is successful and I can "regain My Normal Life"...

Good info Randy, thanks for the post. Can you tell us what you clinically presented with that led to REZUM versus PAE as being chosen the best procedure for you?  Good luck next week....may the flow be with you

Aetna Insurance, my insurance company, has a long list of prostate treatments listed on their website plus the results and success of clinical trials on those...,The REZUM and PAE appeared to be the Most Successful, offered the Quickest Recovery, had the Fewest Complications & Side Effects. as well as, the Least Pain...I talked to Dr. Isaacson about performing a PAE, but he stated the REZUM was more appropriate for my medical condition due primarily to a small, 29 cm prostate, but other reasons too, ie. a low 3.3 PSA, small medium lobe obstruction, etc...Thus, my remaining best choice was the REZUM which I had ~ 3 weeks ago....

Randy I wish you luck with the procedure you had you should do great.  I wish more men with pick other procedure then tupr.  That is a very old and needs to be put out to pasture.  Take care  Ken

Holep is less blood but why deal with the side effects if you don't have to.  I'm 61 and sex is still pat of my life I don't want retro.  It is part of the orgasm.  And when a doctor tells you all will be the same.  They don't know.  They are just telling you what they learned in a book.....Get all the information you can before you pick one.  Have you even had retro.  some man can't deal with it and stop sex all together because it does not feel the same  Ken 

My understanding is HOLEP is very little post surgery bleeding. Yes RE worries me a bit but my prostate has grnumberown into my bladder. I've been told it fairly large but was never given an actual number. I go Sept 20 to discuss HOLEP with a surgeon. Regarding RE I'm on finasteride and flowmax. That said its been quite some time since we've had sex. The past 2 times we did it triggered bleeding. I'm afraid one of these times one of the rather large clots will block me completely

My proste has grown into my bladder. I don't know the exact  size of my prostate. I've had 3 ct scans due to doc seeing spots on other organs. I'm pretty sure they know how big my prostate is. I'll know more sept 20th

Any time they cut your prostate your going to have a problem with RE and retro  Try something else  What about PAE to make it smallet  Holep is easier and les bleeding but it still will distroy the prostate and the bladder neck.  That is were all the problem are  Ken

Also anytime your on them meds you will have retro  Ken