Vascularized prostate?

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Someone mentioned their prostate was Vascularized ( is that word ) and that might be a reason their PAE procedure wasn't successful. I can't find the post so I'll ask in a new discussion. How would it be detremined if you have a very vascular prostate? Would it show up a CT scan

Thanks Unc

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  • Posted

    Hi again - the prostate gland has a tissue structure similar to the lung air sacs. There are millions of tiny fluid sacs called acini similar to the alveoli air sacs in the lungs. So like the lungs the prostate is highly vascularized since blood flow must be maintained to all the tissues lining these sacs. The blood vessel structure detail can be seen in CT and MRI scans. The larger the prostate the greater the degree of vascularization since there is more tissue that must be supplied. As you say this may be why some PAEs fail - like mine. As arteries are sealed, branches may form under pressure and angiogenesis will restore blood flow to the prostate. This is probably why PAEs in general have to be redone every so many years.

    At the other end, with veins it is like sealing varicose veins - it only works so log and then they can reappear elsewhere with a vengence. Nature always wins out in the end. Neil

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    • Posted

      Neil

      As you seem to know why your PAE was not successful and you also seem to have a good wealth of information on the subject, I really feel that you can make the right decision on next step. I am really interested to know what you are thinking since I gone through the same procedure and didn't get the expected results

      Regards

      FJ

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    • Posted

      Thanks for the information Neil. I had 2 pretty bad bleeding episodes that lasted about a week. I haven't bled in a while but I really believe the only solution to the bleeding I HOLEP or a similar procedure. I am presently researching the Focused Laser Abation but there isn't a lot of information on it. 

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    • Posted

      I'd not previously come across the term "Vascularized prostate" but now wonder if that would explain the PAE results I had.

      Large initial prostate volume 163ml.

      Still in recovery room, first toilet visit, flow rate was much improved. I had not been expecting such quick results and tried asking Prof. Pisco why, but his English is ot the best. So I guessed it must be due to the prostate partially deflating when the pressurised blood supply was cut or reduced.

      I also wonder, does PAE just block some of the arteries to the prostate, ... if zero blood supply would the prostate die?

      After 3 months, volume was 136ml.

      At 5 months, started needing night visits again, at 6month scan volume was back up to 156ml, though residual urine volume was still much better.

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    • Posted

      Hi FJ - I am just going to become an expert at self-catherization (CIC) until something better comes along. There are great people on this forum who explain exactly what to do to save our bladders/kidneys in the meantime. Doing self-cath was not on my bucket list of skills to acquire but it is now!

      All the best

      Neil

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    • Posted

      Hello hubgupdown - I agree with everything you wrote here. I think your experience is typical. From what I understand the arteries that are embolized find new paths to feed blood to the prostate tissue which is why the results only seem to be temporary. But the doctor does not cut off all the blood supply since as you say that would kill the whole gland which is not good.

      So it just seems to be a temporary fix maybe for a year to several years depending on the person and then needs to be done again.

      For me I will try to master self-catherization (CIC) to save my bladder until a simple solution is found.

      Good luck to you.

      Neil

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    • Posted

      Thanks Neil

      I think I must prepare myself for CIC since my PAE didn't give good result after 4 months. What I really feel so keen to know is why it didn't work well for me while it worked well for others. It is not convincing to me to say everyone of us is different. I know that my prostate still swelling and for this reason I still taking alfuzosin and NSAID (Ketprofen) which together protecting me from complete retention. I heard you mentioning immunity problem and I heard some guys here mentioning Vascular problem. I heard other guys mentioning median lobe protrusion which I also have. I also heard people mentioning bladder problems which I didn't have. They also mentioned the size and my prostate size was around 70 cc. Anyway, I started to believe that many guys here know more than all of the urologists I have met and consulted. I am quite certain that one day I will find the solution right here at this forum.

      Regards to all

      FJ

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    • Posted

      Hi FJ - Is it possible for you to get a 3T-MRI of your prostate so the IR guy who did your PAE can understand why it didn't work for you?

      But beware! I am also 14 weeks after my PAE with no improvement in my symptoms. So I asked for this MRI so my IR could see all the arteries and explain why it did not work. Well I ahd the MRI last Friday and got the results yesterday which showed "suspicious regions typical of cancer" !! Not what I was expecting. My IR doctor is studying the CD now and will get back to me on Friday - a real shocker - and I still have no insight why my PAE did not work.

      Personally I believe the reason that some PAEs work and others do not is the placebo effect - that is some people show relief because they think they were fixed but may not really have been fixed. This placebo effect can last for years in clinical studies. That is just my opinion. Since your prostate is so small have looked at other less invasive procedures like Rezum (steam) or Urolift?

      All the best to you.

      Neil

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    • Posted

      Thank you Neil

      I agree with you to certain extent about placebo. To me it looks the other way round. Worries about failing to improve or the worse like in my case fear of errors and complications may hinder body positive responses. That is why prednisone works to reverse the effect of worries on the immune system. I wonder why one wouldn't stay on prednisone?. Looking forward to hear the diagnosis of your IR. wishing you all the best

      FJ

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    • Posted

      I'm suprised how little interest their seems to be in following up on failed PAEs. Either where: there was no improvement, as in your case; or a relapse, as in mine. Understanding the reasons for failure might lead to improved methods, or identification of those cases where PAE is unlikely to work.

      I hope your IR can give you a proper explanation of what's going on, and hope you will share it.

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    • Posted

      Totally agree. I've aiways viewed the PAE treatment as a tempory thing. My friend had a minor heart attack. He had a stent put in. Over the years since his heart attack, his body madfe new blood vessels to supply blood the that area. This came from his doc  I remember in HS biology teacher talking about body making blood vessels to supply blood the growing muscles. Only makes sense that blocked blood vessels in your prostate  might cause your body to form new ones.

      I see uro loft the same way. All you're doing is "pinning back" the enlarged prostate. Probably just compressing it. What keeps it from continueing to grow.

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    • Posted

      Hi hungupdown and unclefester,

      I agree with both of you. I started another thread a while ago for guys to report their failed PAEs hoping to see trends if there were enough responses. There was some response initially but it seems to have faded.

      I will definitely share my IRs response. It seems the post contrast images from the MRI were not put on the CD so he will try to get them Monday.

      I too do not see how they will get this procedure ever approved if they don't take advantage of afiled PAEs to learn. We learn more from our failures.

      Neil

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    • Posted

      Hi Neil, I saw your thread and tagged it to see responces. I would love to have a PEA, Urilift or one of the other procedures instead of HOLEP. My biggest problem was bleeding. I a real bad bled event about a year age. It wasn't fun. I passed ( I don't know how) some very large clots. Bled profusely for 10 days. It  stopped then 3 months lattef bled heavily for 7 days.. I have had a couple of smaller events ( pink urine ) but nothing like the first 2 times. Even after 2 CT scans I have no clue what size my prostate is. Nor if it had lots of apparent blood vessels. I don't fault for my uro they just get a report from the radiologist. I did call my uro and request him to get more info from the radiologist

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    • Posted

      Hello uncklefester - I am sorry to hear about your bleeding. Do you know if it could be due to bladder stones? These have been known to cause excessive, periodic bleeding. It is similar to uteran fibroids with women where the fibroids can cause the type of intermittent bleeding you describe. Ultrasounds of the bladder would show them up well.

      Good luck.

      Neil

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