Will TURP be outdated and Will Prostate Artery Embolization be the accepted way to treat BPH

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I ve had BPH for about two years and now it's getting worse. I'm only on alfuzosin and not anything else.

Alfuzosin effectiveness seems to be declining and I would be a candidate for TURP. However I am hoping and waiting for PAE to be offered in Canada. Hopefully in the next few years. Is this a strategy that anyone else has thought of?

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  • Posted

    It depends. The interventional radiologist I met with said I was OK in terms of being a good candidate with a 70 gm prostate and a small but present median lobe, but not ideal. They like big prostates that don't have a massively overgrown median lobe. They also won't perform a PAE on someone who's had prior prostate surgery that significantly altered the arterial architecture.

    My personal view of PAE, and Rezum to a lesser degree, is that they are "blunt instruments" that have much less precision and control over exactly what tissue is removed. IRs will continue to improve their ability to treat only the tissue that needs to go, and to be able to reach all tissue that needs to go. It's just dependent on your particular prostate anatomy and arterial architecture.

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    • Posted

      Russ, You would be surprised to learn that TURP and other invasive methods not performed under MRI control(except for FLA and waterablation) are also blunt instruments.

      It's misconception that they are targeted. Not much more than rotor-rooter in the hands of your plumber.

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    • Posted

      Gene, I can only go by what I've seen from cameras showing what actually happens during these transurethral procedures and what an IR told me about PAE. What I see during videos of different flavors of TURP is that the surgeon's hands control where the electrode cuts or vaporizes. There's a few millimeters of coagulation from the heat but it cuts or vaporizes precisely where the surgeon places it. Now he may choose to resect so it looks like a roto-rooter has been through there, but that's a choice, not a performance characteristic of the instrument.

      With PAE, the tissue that is embolized depends on the vascular structure which is different for every patient and probably not perfectly symmetrical between the two sides. Maybe the better IRs are able to accurately predict the exact extent of the tissue that will soon die when they release the beads into a given artery. I just don't see how.

      Sort of the same thing with Rezum. NxThera's document that outlines the surgical procedure states that the first injection should be 1 cm below the bladder neck and that the approximate diameter of a void created by the 9 second steam blast is 1 cm. But how consistent and repeatable is that? Is the void always perfectly spherical? Are they all 1 cm in diameter?

      All I'm saying is the TURP-like procedures seem to put the surgeon in more control than PAE or Rezum. Not that they're as precise or more precise than procedures that use MRI or even TRUS. I agree that if a surgeon performing TURP is trying to resect out to the capsule that it becomes a bit of a guessing game the closer he gets to the capsule. He doesn't have any real-time imaging to guide him in that direction.

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    • Posted

      Perhaps PAE can be considered blunt, but consider, that with mine the pre op step was an MRA, to map the arteries in the area. Then they use floroskpy (live xray) to get the arterial catheter in position, then they use a contrast agent and cone beam CT to see exactly where blood from that location goes and when it looses it's oxygen. And there are a variety of implantable medical devices to clog these small arteries, I have different items in each side of my prostate. We are not yet quite ready to use nanobots but I expect we will in the future. All these procedures, if they are performed enough, will improve.

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  • Posted

    It seems that PAE is too new without enough long term results to make a decision on whether or not it will be the most accepted method of treating BPH. I like the idea of TULSA Pro for the condition but it too is very new and there are not enough proven results to ascertain it as the most viable method of treatment. What I like about TULSA Pro is that a specific area of the Prostate can be targeted via multiparametric MRI, which potentially allows the surgeon to not only treat BPH but remove specific sections of the prostate known to contain a cancer tumor. PAE can't do that, although limiting blood flow to the prostate could potentially slow down the growth of any tumor known or unknown.

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  • Posted

    Hello, Johnny:

    Your question is interesting and leaves out all the other treatments/procedures for BPH sufferers. If we start with the basics, BPH sufferers usually have symptoms like a weak stream, frequency (at night), urgency, and the feeling the bladder is not completely emptied. As our enlarged prostate pushes up into our bladder and restricts the urethra, we could also experience retention, or what some of us call "locking up." So, with this said, the question becomes how do we reduce the size of the encroaching large and growing prostate so we can get back our youth and not sacrifice our manhood? Our options become:

    1. Meds to relax something (bladder, urethra, etc.) in the hopes that peeing becomes more achievable.
    2. Shrink the prostate with meds or beads (PAE). Consideration is to do the math and does this really result in enough shrinkage to make a difference in the long-term.
    3. Squeeze it with bands (UroLift) so the enlarge prostate is pulled/squeezed out of the way. Size of prostate equals XX number of bands. Prostate has to be an "ideal" size of they will not talk to you.
    4. Remove the mass. Using a procedure to remove pieces of the prostate, or most of it. Here is where our options become interesting, scary, and the last choice for many because it falls in the "invasive" category.
    5. Last, but not least, lets give a nod to the BPH sufferers who choose not to partake in any of the above options and choose to self-cath (i.e. CIC).

    Keying on one part of your question, "...the accepted way to treat BPH," the above list gives us a lot of options. Which one is the gold standard is up for debate, biasness, and fear factor (we should also throw in where you live, your insurance, and economic means). A lot to think about.

    Dave

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  • Posted

    Johnny,

    I;m myself a story of PAE in making. I had my PAE 20 months ago at UCSD in San Diego. Since then IR moved to Stanford and nobody else performs them locally anymore. I'm still enjoying benefits from PAE. My prostate was 110 g with significant median lobe, practically total obstruction of the bladder neck, bleeding often, three time Foley catheter for a week due to different situations, frequent CIS last few weeks before PAE. Relief is still substantial, but waning slowly due to the revascularization and prostate growing again. I hope it will last a few years more and then something newer will come into line of less invasive procedures. First of all, it's not the alfuzosin (I'm 10 years on it without much of side effects and it still works reasonably well). It's your prostate growing and makes things worse. Alfuzosin doesn't stop it to grow.

    I have read on this forum that PAE is already available in Canada (somebody in Manitoba does it). Scan this site. It's impossible to predict what will happen to you after PAE. It depends on your age, prostate size, anatomy of the arteries supplying blood to the prostate, whether they are relatively free from calcium deposits and atherosclerosis.

    This treatment is offered now in USA and many other countries for below $10K and given the amount of complaints related to the whole garden variety of TURP, Resum, and UroLifts, if I were you, I would start with PAE. Except for Resum, practically any mentioned procedure can be applied after or when PAE starts to fail or won't work on you. In most cases PAE doesn't work not due to the central lobe presence but due to the absence of the proper skills from IR doctor. Go for the best and most experienced.

    If my will start to fail, I won't hesitate to repeat it, rather than looking into something more invasive.

    Don't procrastinate and wait! You are damaging your bladder. It becomes thicker and and smaller. Later, even after radical procedure when the obstruction will be removed, the bladder will hardly relax to it's healthy state. That happens to most BPH patients who wait too long. We are talking about your bladder capacity and how many time per night you will be getting up for the rest of your life. Watchful waiting in case of BPH is not a good idea.

    Also don't trust those who will tell you that you can avoid this by waiting during the void and not straining your bladder. It's an illusion. Waiting help to relax the damaged sphincter but not to overcome obstructed bladder neck. YOu need to create extra pressure inside your bladder to open the sphincter and overcame the restricted outlet pressure. No waiting time can violate laws of Physics.

    PAE is the least effective and probably the least lasting procedure but also has the least amount of complications and lasting sexual side effects.

    Good luck.

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    • Posted

      Vernon,

      It's an invasive procedure, which use high intensity ultrasound (kind of high tech scalpel) to remove specific parts of the prostate. It's a bit more computer controlled (temperature ) but otherwise I don't see why is it superior to modern plasma TURP or FLA. Ultrasound is not known to stop bleeding. Probably hell expensive (MRI is involved) and not covered by any insurance. Not sure if FDA approved. Looks like an advertising gimmick to me. Haven't seen research papers or long term success results.

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    • Posted

      Waning a little bit but not to the degree that I would regret havin PAE 20 month ago. My quality of life is still much better than 10 years ago. The only concern is, what should I do a few years down the road. Any invasive procedure is more difficult to endure when you are older than 75. Hope they will invent a stem cell grown transplant by then. Already achieved that for rats.

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    • Posted

      I am only 54 years old , I had severe BPH symptoms at a very young age. PAE Has changed my life, maybe my "youth" is a contributing factor in my positive results. As to long term durability ? Time will tell, but I am in a UCLA PAE study, so i feel very lucky.

      Best of luck to all!

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  • Posted

    Johnny,

    I had a PAE in Aug 2017. My reasoning was that it was the least aggressive treatment for my symptoms and had a high probability of success. However, I estimated my relief was only about 20% and after a year I was back to where I started from. So, in April of this year I had a bipolar TURP. My flow increased by about 50%. The TURP was definitely more effective than the PAE but from the experiences of others here this can vary from person to person. Both operations were easy on me and recovery was fairly fast. If you wait too long for treatment you risk permanent damage to your bladder not to mention your quality of life.

    Tom

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  • Posted

    Dr. Welsh in Calgary, is a specialist in vascular and interventional radiology, including uterine artery embolization, and prostate artery embolization (PAE) - a novel, minimally invasive treatment for prostatic symptoms.

    Doctors from Mayfair Diagnostics have been performing this procedure for five years at Calgary’s Rockyview General Hospital.

    Dr.Welsh did my biopsy, otherwise I have no more info on this procedure in Calgary

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