Has anyone had multiple PAEs either because the first one didn't help or because over time the benefits wore off requiring another one? Were there any adverse side effects? I had a PAE 30 months and while it did reduce my prostate size by 40% it did not relieve any of my BPH symptoms and now the prostate has regrown to its original size (300cc - no median lobe). Thanks.
Hi, Howard,
Nice to find you here, too! We have corresponded in the past, but there is so much traffic these days that it is easy to forget. Plus, I have had spells of absence.
All the best and Season’s Greetings, alan86734.
Hi Howard:
We were conversing in your previous thread. I can’t answer the PAE question, but do you mind if I ask how old you are?
My understanding is that a 40% reduction from PAE is pretty typical if not quite good. What makes you think a second procedure would work better for you since you said it didn’t relieve your BPH symptoms. Assuming you weren’t doing CIC prior to your first PAE procedure, are you just trying to no longer need to do CIC?
Yes, first one worked great for about 18 months, but second one was unsuccessful.
Thanks Alan for the good wishes and of course I wish you good health and happiness for 2019 and the remainder of 2018. My best gift this season will be to hear that my recent MRI is clear of any suspicious regions!
Take care
Howard
Howard,
I had a PAE - and it helped me a bit, and I was able to get off Flomax. But now, 16 months later, I am back on Flomax and considering my next option. I was considering a second PAE, but am now looking for a more aggressive solution - like a bipolar TURP. In your case your prostate is very, very large and you might need HOLEP or a simple robotic prostatectomy. In other words, you really need to reduce your prostate size IF that is what is causing your issues. If your first PAE didn’t solve your problems, you have to get a clear answer why. Was it a median lobe issue? Is your bladder unable to empty? I would wait before moving forward with any other treatment until I was sure what the issue(s) is/are. You wouldn’t want to undergo additional surgery then find yourself back where you are.
Tom
Hi rdemyan,
I am 69. I think this recent UTI has thrown me for a loop. It is my first one in over 3000 self-caths . I had hoped that doing CIC would be temporary until a new truly minimal BPH “cure” was found. There are 2 companies that have been working on novel, once-a-year injections into the prostate that seemed to reduce BPH symptoms in clinical studies. But both companies are now failing financially so it looks like CIC forever.
I am not a big fan of PAE for many reasons but since I had it there have been some advances in how it is administered. Also it is now covered by insurance. The main problem with PAE is that it cannot target directly the blood supply to the peri-urethral region where much of the BPH lives. But if advances in technique have improved this capability then it might be worth a second look before trying something more invasive. Hence my new thread here to see if its effectiveness and durability have improved.
Hi Tom:
I hear what you’re saying and a guy should understand all of the issues to make sure that a BPH surgery is the right way to go. But when you’re prostate is 300 grams, it would seem to me that a reduction in size is absolutely necessary even if it is ultimately only a component of the overall treatment needed. In other words, it’s hard to imagine that the symptoms are not at least partially due to a prostate this large in size.
Hi Howard:
Yeah, I think I know the drugs you are talking about. One of them is fexapotide triflutate. I had high hopes for it as well. I did some internet research on it and found a blurb in an FDA posting that it was shown to reduce the size of the prostate by 20 to 25% after a month. However, it’s produced by a startup company, and as you note, they are close to bankruptcy. Plus who can trust the self-reporting of results when the company’s survival is on the line.
Can I ask why you don’t want to have one of the BPA surgeries intended for large prostates. If it were me, my main concern would be a procedure that has the lowest probability of incontinence. RE is something I think a guy can readily learn to live with. Impotence, is more undesirable, but you have to weigh the risks versus the rewards. I know I’m not telling you anything new, but it just seems like with a 300 gram prostate you have to do something more “radical” than PAE. A 40% reduction still leaves a 180 gram prostate.
Whatever you decide to do, best of luck and may your MRI show no issues.
Hi Tom,
Thanks for your comments. I am a disciple of jimjames (and miss him very much on this forum ) and he always advocated for what you say here. I do know that I do not have a median lobe at all from a recent cystoscopy.
But here is an interesting test I do from time to time. Every six months I take one prednisone tablet (20mg). This is a potent anti-inflammatory. So if all my peeing problems are due to my large prostate, which is mostly caused by hyper-inflammation then I should be able to pee better. And in fact that is what happens. For about 2 days I pee like proverbial race horse with just a minimum residual. But then when the prednisone wears off I am back in the stall again ( literally). So I know my BPH causes all my problems. Prednisone is a dangerous drug taken over time so it is not the solution.
CIC has literally saved my bladder and kidneys these past 2 years and in fact has allowed my bladder muscles to regain their strength.
The nice thing about FLA is that it targets just the offending tissue around the urethra that is compressing it. So even though FLA may only take out 20% or less tissue it is very effective in reducing BPH symptoms. PAE on the other hand tends to target tissue in the outer regions of the prostate which is where my 40% volume came from and none of the offending tissue was removed. PAE can be more aggressive in getting in closer to the urethra but then it runs the risk of embolzing the urethra or rectum or bladder!
Thanks for your good wishes. I am very nervous.
I agree with you. But the only surgical procedure offered to me locally is an open simple prostatectomy which the urologist said is risky for my size due to bleeding. To get the other procedures I would have to travel and be away from home for a few weeks while I recover in a hotel room, assuming no complications. This is very undesirable but if that is my only option I would have no choice. The nice thing about PAE is that I could be home in just a few days. FLA is in between but the cost including hotel and travel would be over $30,000 as it is not covered.
I had my second PAE six weeks ago. The first one lasted 3 years before I decide to have another one since my insurance covers it now. I am hoping for at least 3 years and maybe 5 since they were a little more aggressive this time using smaller beads with the procedure. So far the results are ok, but hoping for more improvement. I am peeing with no medication. Have no idea what the size is at this point. I am 76.. Wish you all the best.
Howard,
Have you considered Finasteride to shrink your prostate?
There has been controversy over Finasteride and increased G7+ cancer (see Prostate Cancer Prevention Trial, which began in 1994). Recent studies seem to overturn the earlier findings that implicate Finasteride in more aggressive cancers.
Finasteride has a long list of potential adverse side effects including gynecomastia (male breast enlargement), depression, loss of libido, reduction in semen production, ED, etc. Nasty side effects to be sure.
But if it can shrink your prostate by 30%, say from 300 cc to 210 cc, you might have a better outcome with either a traditional open partial prostatectomy or a robotic prostatectomy. Granted, that is major surgery.
I recently talked with my urologist, who is one of the top prostate surgeons in the world at one of the top urology centers in the US, and he said if he did a partial prostatectomy on me (my prostate, depending on source of measurement, is 150-175 cc), it would not grow back in my lifetime (I am 60, so I have another 10-20 year life expectancy).
Of course, you can look into HoLEP at places like Indiana University Hospital, Vanderbilt, Mayo, etc.
I want to avoid intra-urethral procedures. I’m not a candidate for TURP - and frankly, would never consider if even if my prostate were small enough.
I’m sorry to hear you need to repeat PAE. I know there are many success stories with patients of Drs. Bagla, Bhatia, Isaacson and others, but there are many failures as well.
As I try to tell my wife, there are no sure things when it comes to the prostate. All procedures carry certain risks and different outcomes, with wide variation from man to man. Even the process of trying to detect cancer is difficult, as many men and their urologists “chase cancers” for years, repeating biopsies and PSA tests, MRIs, etc. trying to find the cause of elevated PSA in the face of repeated negative biopsies.
I do wish you the best, Howard.
Michael
Howard,
As you stated, prednisone is a dangerous drug, and 20 mg is a high dosage. Are you consulting with your doctor when using prednisone in this way?
Your results are interesting and certainly suggest the inflammation component that is causing your urinary symptoms.
Others on here have tried Serrapeptase. It attacks inflammation. Completely natural and might be worth a try. Note: it positively must be taken on an empty stomach in order to have any effect.
I also believe in natural anti-microbials, and so I eat a lot of onion and garlic - in guacamole, in soups, with roasted vegetables (all organic, by the way) - to get the health benefits of these. Also, large doses of Vitamin D (30,000 IU per day) to help the immune system.
I attack the problem this way because I suspect some of the inflammation I have is due to a chronic infection I received from my biopsy in 2015.
And Howard, please read up on estrogen mimicking chemicals and estrogenic foods. Avoid these. Try to eliminate all dairy products, or only consume 100% organic dairy. Eat only grass-fed and grass-finished beef. Avoid plastic containers (BPA is an estrogen mimicker). Men’s bodies are being devastated by the xenoestrogens in the environment - and this is leading to the meteoric rise in prostate cancer and debilitating prostate enlargement.
If you give these a try, please let us know if you experience any improvement in symptoms.
Michael
Howard,
From what I have read on this forum, Dr. Bagla is able to target the median lobe using PAE. I believe this was a problem when PAE was first introduced. I am not 100% certain of this, but I have read it here several times.
Dr. K can target BPH nodules near the urethra, with about 2 mm precision. He is not concerned so much about the overall prostate volume as he is the effectiveness of targeting adenomas (non-cancerous nodules) that compress the urethra. He had to refocus my thinking as I was centered on prostate reduction - i.e., quantity of tissue removed, not quality (effective targeting) of tissue removed.
Michael
PS - what happened to JimJames? I know he was a huge advocate of CIC and saw him on this forum numerous times.
Thanks Michael for this wealth of information. Did you have FLA with Dr. K?
I have been on Avodart for 15 years now. Initially it did reduce my prostate volume by half and my BPH symptoms. But over the years it has lost its effectiveness and my prostate regrew and continues to grow. But I cannot get off this terrible drug due to “dudasteride syndrome” where the prostate then makes massive amounts of DHT which grows the prostate at an accelerating level.
Thanks for your other comments and advice. I try to limit hormone containing foods but it is difficult. I am mostly a vegetarian now but do eat eggs and biologic yoghurt.
I will look up some of the other items you mention. I don’t do the prednisone as much now but it sure gives the illusion of the fountain of youth.
All the best to you and thanks again. Howard
You’re welcome, Howard.
I never head of dutasteride syndrome…makes me leery of going back on Finasteride. I was on it somewhere around 8, 9, maybe 10 years ago. Didn’t like the side effects but it dropped by PSA. My prostate was smaller then so my LUTS were much less bothersome.
I have not had a procedure done. I did consult w/ Dr K. Of all the options, FLA performed by him is my preferred treatment. It comes down to $$ for me.
To protect my bladder and kidneys I may consider open prostatectomy. I know it has risks and a longer convalescence, but if it will keep me “open” for the reminder of my life, then maybe it’s time to do something major.
HoLEP is still on the table, but again, I don’t like the procedures that go through the penis.
It’s a little disheartening to read of failed PAEs. I had hoped it would have a higher success rate.
Look into DIM supplementation. Research how it may/may not reduce DHT conversion.
I think this ultimately becomes a multi-faceted approach for men who don’t do surgery: diet, supplements, rule out infection, attack causes of inflammation.
I’m still considering Dr Bagla because PAE is covered by my insurance.
Thank you,
Michael
Google “HolEp vs open prostatectomy”. Everything favors HolEp.
Thanks Michael. Why not consider also CIC? If I can learn it anyone can and it protects the bladder and kidneys. I’ve been able to integrate it into my life ok. This was my first UTI in over 3000 catheters so that is a good record.
Also there is the robotic simple prostatectomy which is much less invasive than the open one. I am also considering that too.
All the best
Howard
Oh and also please stay away from proscar/avodart - they are poisons! They ruined big parts of my life.