Consider PAE by an IR as first option

Men's health
1

(for enlarged prostate)

Hi everyone, Many of you have good and bad experiences. And many are reading these blog sites to try to figure out the best option to address enlarged prostate. I have a fair amount of experience in the matter:

1) I went to 5 different Urologists for help

2) I tried FlowMax (I called it "FloMin"!)

3) I had Greenlight - A waste to try for larger prostates

4) I had TURP - It provided less than 12 months reprieve

5) I had HoLEP - It has worked great, though I now have retrograde ejaculation and probably lower testosterone

6) I know a fair amount about PAE (Prostate Artery Embolization) because I have many IR (Interventional Radiology) Doctor friends.

The point of this note is to help out you all realize the following:

1) PAE may be by far the best procedure for enlarged prostates. Why? Because it is non-invasive, it does not gouge out portions of your body, it probably is the best at helping you keep your testosterone/libido high, you can go back in if necessary and do it again, and if you decide later it was not as effective and you want to try TURP or something else you can.

2) You are wasting your time asking Urologists about PAE because none of them do PAE, it is a different type of procedure only done by IR's. 

3) You are worth money to doctors, so expect very biased advice. They will only recommend procedures they are trained to do so they can make money off of your body. For example, I went to 4 Urologists who never once mentioned HoLEP as an option. When I found out about HoLEP through online forum sites I asked 3 of these Urologists what they thought of the procedure. All 3 said it was risky and not worth doing!! Most of them really tried to sell me on a 2nd TURP procedure. The bottom line is these doctors do not want to retool because it takes time and time is money, and there are too many of you patients out there who are not going to question the advice of your Urologist!

PAE is becoming mainstream in Europe and Australia and has started to be successful in the US. There are several very experienced IR doctors who can help you. 

I suggest you all just search "PAE (and major city name)" and see what comes up. Chicago is becoming a hotbed of experience for this non-invasive procedure. Just look for "top IR doctors (and a major city)" and see what comes up. I can help you find great ones in Chicago.

I am not upset I had HoLEP because it really helped me. But I wish I knew about it early on and had tried it. I am pretty sure it would have solved my problems and helped my manly functions work optimally. 

Lastly, if some of you are on anti coagulants,that may be another good reason to consider PAE, since it is non-invasive.

Remember, Urologists are not going to recommend PAE and many will not recommend HoLEP. It is up to you to do your homework!

2

Thank you. I came to the same conclusion after some research . This site helped immensley in my search for a non invasive procedure with tth least sideffects.

3

Thank you Bill. That is the best summation of treatment options available for BPH that I have ever seen, 

My own reasoning when deciding which option to choose was to go with the best option first which was PAE. If it didn't work I could try the others. As it turns out my PAE was extremely successful. 

4

Please give me advice on choices in Chicago. I agree with what you said; alot of doctors just look at the body as a way to save money.

5

What I meant is urologists just see so many guys daily; moneymaking is a factor and it is their bread and butter; part of it may be unconscious and I guess you can rationalize anything.

6

I had a good result, so far, from TURP for which the stats are good.

I have nothing against up and coming treatments though such as PAE.

All treatments can have negative outcomes though TURP, PAE and many others. 

The most important thing is to find a good surgeon who is very experienced in the procedure to be done whether it is TURP or PAE.

The other thing that helped me make a decision was to look at the objective stats that governments use to assess treatment outcomes. In my case TURP. Reading forums will only get you a collection of stories, some good, some bad. PAE has risks too as the prostate dies, the dying tissue can cause issues so nothing is ever perfect. No treatment ever is.

The prostate is very complex and the issues vary from person to person. Some patients here on the forum have complicated medical histories and problems and it makes sad reading.

7

Another useful note, if PAE did not work for the first time, you can always go back to do it again. Theoretically, the reason it failed may just be that doctor did not block the right artery. Therefore finding a good doctor with experience is important to get good result on PAE. Down the road, years after PAE when BPH becomes problematic again, one can also go back to do it again.

8

Luo61644 said it right. The prostate has many arteries. Reducing flow to the right one is an art and science. For Chicago, the only Top 50 IR I believe is Steve Smith. Just type his name and PAE and you will find him and a lot on PAE.The other pro is Bob Vogelzang. Both these guys have made many many breakthroughs in the field of IR. Sometime I'd like to publish a list of everything the pros in this profession do, you will be very surprised and enlightened. There are other guys in Chicago who work for these guys too.

9

I would have to agree. I am 47 and I have so much pain. I can hardly urinate, but I don't want to go in because of what it may mean to my sex life or lack there of if I do a proceedure like TURP. My dad had TURP and though he doesn't talk about it I know that it ruined his sex life. Why must we trade that for relief from symptoms. I have finally had enough and I am seeing my doctor friday. really scared. I don't want to be screened for prostate cancer. I believe I have Prostititus if so then hopefully antibiotics will help. If it is BPH then I am in real trouble. Getting that at my age means bad things for me as I age. My dad had BPH really bad, so it makes since that I would have it as well. On a positive note at least no man in my imediate family has had prostate cancer. This means at least I am low risk. This is why I do not wish to be screened. I hate the urologist, what a modern day medical mangler they are.

10

How does one find a doctor who has personally had BPH? I am sure that such a doctor has done more research on the subject for his own well being, Doctors do not discuss their own medical problems with their patients and so we have to hope that they are giving us their best professional advice.

11

somewhere in this forum there is a doctor wrote some investigation on BPH. You have to search for it

12

Northwestern is conducting clinical trials. I considered getting a PAE there before I found that they were being done at St. Louis University hospital in St. Louis. Northwestern is more prestigious than SLU, but I'm very close to SLU.

You don't have to be approved for the clinical trial to get the procedure, but that would defray some costs. Even with insurance, my cost was about $4000.

13

Here is my plan to deal with BPH if medicine intervention failed or reluctant to take it, PAE is my first choice, then Urolift,followed by HoLEP, finally Turp or green laser...... So far with only 3 weeks, PAE seems work great

14

For Craig84609: Verify with a Urologist you do not have cancer and ask what he or she recommends, then get to a good IR for a 2nd opinion. Chicago has them. Other major cities probably do too. But also check to determine the size of your prostate. I had prostatitis, but I also had a very enlarged prostate. Some people have small prostates with prostatitis. Others have small prostates but the lobes or whatever are shaped or positioned such that some people are more susceptible.

Regardless of whether you come to Chicago for help, search "VIR Chicago" and you can read up on Dr Steven Smith. He is a really advanced IR. The procedure is new to the US so do not expect to see a lot of stuff online in the US yet. I would get a consultation from him via phone to start. Or try another IR in a major US city. I am led to believe the downside risks are negligible and the procedure is non-invasive. A great fallback procedure would be HoLEP, and it worked great for me, but it cores out your prostate, and along with it can go your libido and possibly cause retrograde ejaculation. If you want to seriously consider HoLEP, the godfather of it is Jim Lingeman in Indi. He did my procedure. But I definitely would try PAE from an IR first given the chance to d it al over again. Good luck!

15

In reply to Ramblin, and others: In Chicago, 2 places I know of are trailing PAE and have done some cases:

Northwestern Medical - Dr Bob Vogelzang is the top IR there.

VIRChicago (owns and runs the IR group for 7 Chicago area hospitals) - Steven Smith is the only IR Doctor to make the Top 50 Chicago doctors list

Both of these guys are pros. They both know each other. You will be in good hands with either.

16

I don't think cancer is an issue. I have had prostititis on and off over the years and I think this is what is going on right now. The only way to check for cancer is biopsy and that is not something I am willing to consider. I am low risk as no men in my family have ever had Prostate cancer. Also not willing to go through cancer treatments for it if I did as my quality of life would suffer. But I will try to get help for BPH or Prostate infection. Again it can't be at a cost of not functioning that is why PAE sounds like a good option as far as keeping things working. I am to young to have a functionless prostate. If I were 75 or older well then I guess I would have to deal with it. Thanks for the info as I would imagine that this treatment will be more redily available by the time I need this.

17

Unfortunately this is not FDA approved therefore not covered by Medicare. Hope that will happen soon. I am on the verg of either a TURP or because of prostate size a "simple open prostatectomy". 

18

That is a real shame James. You might talk to Bob Vogelzang in Chicago to see if they are offering any financial relief or know ways for getting the procedure funded. Seems to me that Medicare would at least cover it up to the same amount as TURP. For me, TURP lasted only 12-15 months (and I had it done after I had Greenlight done!). The last procedure I had done was HoLEP which has taken care of things. But when you core out your prostate you can expect to lose some libido. I do not know the stats for either procedure on retrograde ejaculation, you might ask.

But if you really feel you cannot wait, I would contact James Lingeman, a Urologist, in Indi, and get HoLEP. He is the founding father in the US of this procedure, he has done 3000+ I believe, and it has worked great for me. He has clinical studies showing near zero ongoing issues with HoLEP V's TURP. Your Urologist probably doesn't do TURP because he or she just doesn't want to lose the downtime and money trying to learn it. HoLEP is also done by one of the Mayo Clinic locations.

But if you can hold out, go for PAE.

19

The FDA needs to get their heads out of each others back sides so that they can get something worth while approved. I would opt for PAE if available.

20

I have just seen some information on a procedure called iTind and the statements and details are quite remarkable. Have you looked into this? Says available in the EU, Canada, Hong Kong and elsewhere but not yet in the US.