Reasons to not try a PAE first?

Hi guys,

I've been taking my time researching all the procedures and learning from everyone on this board, past and present. I'm indebted.

I'm 52, have a 71cc prostate (per MRI) and have classic BPH/BOO and possiby some CPPS on top of it (that part seems to be clearing up). I'm trying to list reasons why NOT to do the PAE and just go straight to aquablation or epTURP (ejaculation sparing TURP).

It just seems if you have 3 to 6 months to try, it's worth trying the PAE isn't it? I don't see why not try it and maybe buy a few years with it and also make sure your issue is BPH/BOO and not something else (neurogenic, bladder or detrusor issues or advanced CPPS-related issues).

That said, there are much smarter folks here on this board, what would be reasons not to do the PAE? Here is what I have listed and more logical arguments:

1. you could be allergic to the microspheres and you won't know that until it happens (no way to reverse that). this is super low probability chance and would be like saying don't do a TURP because you may end up being incontinent.

2. doctor error and adjacent tissue necrosis or you truly end up with erectile dysfunction (one urologists told me on the way out the door that this was under-reported) ; ED (erectile dysfunction) can be as high as 56% post PAE suggesting that early success was under-reported (16% RE, 40% diminished ejaculation). This was compared to TURP so not sure if urological community was trying to downgrade PAE here. Is 40% "diminished a big deal"?

3. PAE syndrome - this is just pain of recovery and all procedures have this. This was mentioned by a diff urologist as a reason not to do a PAE (he said google it) but not sure his point --all procedures can have difficult recoveries. Maybe he is referring to a permanent PAE syndrome?

4. you don't have time to waste or see if the PAE works for you -which is 3 to 6 months. The maybe of it is not as certain as a urological procedure - that said, there are no guarantees with a TURP or aquablation either. and those are options after a failed PAE.

5. PAE may not be as good for median lobe. that's what I read here but the interventional radiologists will refute this and say it does work for median lobes. Maybe some are better than other at targeting.

6. PAE's early success can be reversed on a dime later - this I've read on this board that all of a sudden, good outcomes went south - we don't know how many that represents and all procedures could be a failure or turn into a failure as the prostate re grows

7. If you do a PAE, blood flow to the area will be restricted which would make antibiotic treatment for any prostatitis difficult - most people don't have CBP and over 50 won't catch acute prostatitis. the peripheral area is where you have prostatitis and those will not absorb most of the beads so ABX will still reach. ABX is difficult to get into the prostate anyway.

Any help in my thinking would be great. Retaining my ability to ejaculate is important to me.

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