Upcoming PAE at Inova, Alexandria, VA

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I am having the PAE procedure on November 20th at Inova Hospital in Alexandria, VA.  The procedure will be performed by Dr. Sterling.  I asked Dr. Sterling if he trained or worked with Dr. Bagla when Bagla was at Inova.  He cleared his throat and said "WE trained Dr. Bagla".  I guess Bagla has the following but was not the first at Inova to do the procedure.  Dr. Sterling said he used "Cone Beam Ct:" which allows him to precisely locate the location of the beads.  I told him I have severe reactions to Prednisone and he said there was no problem and he would prescirbe other drugs post procedure.  I will keep everyone up to date on my experience and results.

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  • Posted

    thanks for the information and good luck to you.   keep us informed
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  • Posted

    Best of luck!  Please let us know how it goes.

    Do you have an enlarged median lobe?

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    • Posted

      Yes, my prostate is about 3X normal size.  I have read all the post saying that PAE would not work with a prostate with a median lobe.  I am not clear on why shutting off the blood flow to the prostate would be shrinking some parts and not others. Most of the literature I have read references prostate anatomy in "Zones" so I am still not clear on the distinction and how or if they relate.  Hopefully with the Cone Beam CT, he will be able to locate the beads to be most effective.  I chose PAE because if it does not work, I can always try another procedure.  At least this procedure seems to have the least liklihood of adverse affects.  I consulted with three Urologist besides the Interventional Radiologist prior to making a decision.  Most of the old timer Urologist stick with the TURP.  The last one I visited in Frederick, Maryland, a younger Dr.,  said "Yes, I think PAE is a good option for you to try".  If it does work for me, then perhaps I can help debunk the "Median Lobe" mantra.

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    • Posted

      The PAE docs I've spoken to all say their results are much less effective when there is an enlarged median lobe.   I'm sure that doesn't mean that it's never effective in such cases.  Good luck!

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  • Posted

    How much will it cost and does your insurance cover it ? Hank
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    • Posted

      Medicare covers it and I also have supplimental insurance.  I had hematuria associated with the BPH.  I don't know if this is a qualifier for Medicare payment or not.  Of course, after the fact there are often some things that are not covered by by both.

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  • Posted

    Good luck on the PAE.  I had mine done 14 months ago by Dr. Isaacson at UNC.  It has been a miracle for me and hopefully will be for you as well.  Dr. Isaacson told me that when all the prostate lobes are enlarged they have great results.  If only the median lobe is enlarged the procedure is not as effective.  The first week post procedure was uncomfortable at times but I awoke on Day 8 and felt like a new person and slept all night without needing to urinate. 
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    • Posted

      I also had my PAE w/ Dr. Isaacson.  He told me something a little different.  When there are enlarged median lobes, the rest of the prostate is also enlarged.  The question is how large is the overall prostate.  The larger the overall prostate is, the smaller percentage of it is made up of the median lobe.  So, overall the results would be better when the ENTIRE prostate is large.  When comparing a PAE of the same size overall w/ another the same size but w/ an enlarged median lobe - it is much less effective.

      Please keep us informed of your results over the coming months.

      Best of luck!

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    • Posted

      Ok, there is a lot of confusion (at least on my part) distinguishing "Lobes from Zones"

      Here is what I found:

      Name

      Fraction of gland

      Description

      Peripheral zone (PZ)

      Up to 70% in young men

      The sub-capsular portion of the posterior aspect of the prostate gland that surrounds the distal urethra. From this portion of the gland ~70–80% of prostatic cancers originate.[13][14]

      Central zone (CZ)

      Approximately 25% normally

      This zone surrounds the ejaculatory ducts. The central zone accounts for roughly 2.5% of prostate cancers; these cancers tend to be more aggressive and more likely to invade the seminal vesicles.[15]

      Transition zone (TZ)

      5% at puberty

      ~10–20% of prostate cancers originate in this zone. The transition zone surrounds the proximal urethra and is the region of the prostate gland that grows throughout life and causes the disease of benign prostatic enlargement. (2)[13][14]

      Anterior fibro-muscular zone (or stroma)

      Approximately 5%

      This zone is usually devoid of glandular components, and composed only, as its name suggests, of muscle and fibrous tissue.

      Lobes

      The "lobe" classification is more often used in anatomy.The prostate is incompletely divided into five lobes:

      Anterior lobe (or isthmus)

      roughly corresponds to part of transitional zone

      Posterior lobe

      roughly corresponds to peripheral zone

      Right & left Lateral lobes

      span all zones

      Median lobe (or middle lobe)

      roughly corresponds to part of central zone

      The Radiologist report on my 3T MRI says that my prostate measurements are:

      5.9 cm in transverse diameter

      4.9 cm in AP diameter

      7 cm in SI diameter

      Prostate Volume 89.7 cc

      and states "The transitional zone is markedly enlarged and heterogeneous"

      So, to me and the information above correlating lobes and zones, it seems as if my enlargement is in the "Anterior lobe or Isthmus"

      Hope the above solves some of the anatomy confusion in case others are also having trouble distinguishing lobes from zones.

      Paul

       

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    • Posted

      I had my PAE 25 months ago. Last week I sent my 3T MRI scan to Dr. Isaacson for his review of a possible cancer lesion. He took a look and called me and stated that he could not rule out that the area in question is not cancer so advise me to have the fusion biopsy, which I plan to do in Dec. He also stated that the scan shows that there is room for a lot of improvement to reduce my prostate. He took the time to explain why.  If my biopsy indicates no cancer then I will have another PAE procedure with him next year sometime or 2019. The original procedure reduced my prostate by a little over 30 percent. It appears he is a little more aggressive in reducing the size of the prostate now, than he was 2 years ago. If I have cancer then that will have to be addressed before another PAE procedure can be done. 
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  • Posted

    Dr. Bagla did my pae. I was told the same thing by dr sterlings staff at Inova. Then I forwarded the email to Dr. Bagla and he then cleared it up quickly. He did his fellowship there at Inova. When he was a fellow, they never did pae. Dr. Bagla learned on his own and alongside other IRs in other parts of the world. Dr sterling did NOT train Dr. Bagla in pae! When he left INova a few years ago, the the other doctors had done a total of 1 PAE alone compared with his hundreds. Dr Sterling is clearly using word majic to say he trained Dr. Bagla, but truth is he didn’t train him on pae as they never did it in 2007 when he was trained. Call Dr. Bagla to get an opinion at least bc the procedure was quick, 1/5 the radiation of what they do at Inova and he has more experience than anyone in the US
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  • Posted

    Hopefully you read the other post! Dr sterling did not train himself Bagla to do pae. They didn’t do pae until Dr. Bagla did it at Inova. Make sure you go to the best people for this! It can be risky if not done by experienced doctors
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