Question for those who have had PAE or are very knowledgable about it. PAE works by embedding microspheres in arteries/blood vessels that supply blood to the prostate. The microspheres significantly reduce the amount of blood reaching the prostate and this causes prostate cells to die and the prostate to shrink. It is well known that antibiotics have a difficult time reaching the prostate. So if a man has PAE and then has subsequent prostatitis caused by bacteria, won't the antibiotics have an even more difficult time reaching the prostate? Could the PAE make it almost impossible to cure prostatitis caused by bacteria using oral antibiotics? Would a man in this situation require direct injections of antibiotics into the prostate? Is that even an option?
Hello
Hey there . The injection is a last resort treatment. It is done through the perineum with very thin needles right into the prostate. After PAE your prostate will still be there but smaller. They do not damage the prostate. It does work very well. It has a 70% rate of doing well.
Take care…Ken
Thanks for the response, but antibiotics rely on blood flow to reach their target. It’s already difficult for them to get to the prostate. Lower the blood flow via PAE and it seems likely it will be very difficult for the antibiotics to reach the prostate via the blood. Many men with BPH also suffer from prostatitis.
Anyone have any direct experience or been advised by their uro or IR regarding this question? Thanks.
wow, I’ve asked the same question, almost to a word, on this forum
I would like the answer to that as well. It is one of the reasons I am a little reticent to go through w PAE.
Ken is correct in that antibiotic injections are an option but as a last resort.
I would want to rule out, or treat, bacterial prostatitis BEFORE undergoing PAE. But your question is a good one for what might happen after PAE.
When the blood flow is cut off, the blood vessel and that area which the blood vessel serves dies. So you are left with only areas with a normal blood supply. The idea that a healthy part of the prostate is permanently blocked is incorrect.
Good Morning Buddy.
What you are saying is very true. Antibiotics do rely on blood flow. But with the injections they are put straight into the prostate through the perineum so they do not have to travel anywhere.
There was another guy on the other day talking about a drug for prostatitis called Monurol ( Fosfomycin ) This drug would travel in the blood . They found out that this is the only drug that will get into the prostate. The trail was done on 20 men 17 of the 20 had a 85 % clinical cure. This was in 2015.
They stop using it because the stuff they use now did work. When I see my urologist I am going to ask him about it. Maybe I will try it next time when I get prostatitis again. Instead of Cipro.
Have a great day. When we have question this is when we all learn…Ken
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TG
Thank you for that comment. That is true. If this procedure killed the prostate you would have more problem they shrinking it. It would also kill anything that is attach like the nerve bundles I don’t think we what that
Have a great weekend…Ken
I do not have a good answer. but I had the PAE procedure 3 years ago and again this past Monday. During those 3 years I did notice I had almost no flare ups with prostatitis which I had been dealing with 20 plus years prior to the procedure.
So in my case it reduced the prostatitis flare ups.. Good question…would be nice to have some real data on this.
This makes sense. Also, the same dead areas would not be a place where bacteria would likely survive.
Oral antibiotics have difficulty getting into places like the prostate which is why the Fluoroquinolones (e.g. Cipro) are a popular choice for this problem. They have a fluorine molecule which greatly increases the tissue penetration (apparently).
The problems with Cipro etc. have been written about on these discussions already (or see the Fluorquinolone antibiotic pages), but also bear in mind that a meta-analysis of available data showed in 2012 that both Cipro and Trimethoprim (an alternative AB) were ‘no better’ than placebo. It has also been stated that 95% of prostate problems are non-bacterial. (If I give links this will be moderated but ask if you want them).
Doctors are very keen to give out oral ABs without ever finding out if the problem is bacterial or not. Only if the problem isn’t resolved do they decide it was non-bacterial after all! This is back to front medicine, and, unfortunately for many men, the lengthy course of Cipro taken ‘just in case’ ruins their lives. (And they still have a prostate problem to deal with on top!).
The areas that dont get the blood die off and get reabsorbed by the body, This shrinks the prostate. The Dr’s know exactly where to do this. The prostate keeps growing also. I’ve heard of PAE being done twice. . PAE is done to treat BPH not prostitis so thats a separate issue. But I’d rather have a smaller prostate with prostitis.
Ozone is a gas, was commonly used to treat infections until penecillin developed. These days it’s still used because of antibiotic-resistant infections. As a gas it can be injected IV or infused into the rectum or fills cavities or inhaled.
Ed, can you just get PAE over and over again ? Hank
Yes you can. I just had my second one… If this one last five or so years this time and nothing better is available I will do it again. I was told there are at least three reasons why individuals are rejected for this procedure. The blood vessels are to small or to diseased, if there is cancer present some will not proceed and the structural relationship of the vessels and the surrounding organ are such that a safe procedure could not be preformed in their opinion. . I have no idea what the percentage would be ..
Hi Ed:
Can you let us know where and who did the procedure for you? Thanks.
Dr. Ari Isaacson at the Univ. of North Carolina Medical Center. He did both of mine.
How much and how did you pay for it ? Thanks. Hank
I’ve had BPH for 15 years. My dad and grandad each had prostate cancer. I’ve having PAE next week. Yesterday I had a flow dynamics procedure. Then computer problems meant they lost the data and I had to go through it all again. It wasn’t as bad as fractured ribs but it was a close second. It’s been 15 years of always needing to know where the nearest toilet is so I’m hoping the PAE helps that.
The first time 3 years ago it was totally self pay and they was given a fix price of 6500 dollars. My insurance only covered part of the CT scan.
They now have a fix rate price of 10,500 for self pay which is what they charge medicare which covers this procedure.
I have private insurance and they are covering about 70 percent of the cost. I had to pay the rest upfront before I was scheduled for the procedure. They took my Visa card. They schedule you for hour of registration and paperword/wrist band, 1 hour for prep.. port in arm, dress for the surgery suite, checking vital signs. etc , 2 hours in the surgery suite… first 1/2 getting you and everything ready/checked including placing port in the femoral artery and then 1 1/2 for the actual procedure. They take you back to the prep. room where to lay on your back for 2 hours which is required if they enter through the femoral artery and then you must pee on your owe before they let you leave. The Dr. checks on you doing this 2 hour period.
Every time you get a PAE you are killing more and more of the prostate gland. First the embolization creates severe localized inflammation (phlebitis) followed by the immune system trying to produce local clots (thrombosis) followed by dead and dying tissue (necrosis) followed by localized fibrosis. None of this is good for the gland. Furthermore there is increased risk of embolizing close to the vital tissue of the urethra, rectum and bladder wall. Then there is the possibility of blood clots going to the heart. Also the inflammation zones create damaged tissue regions where gene mutations can occur and cancer. I had this happen to me after my PAE and the lesions were traced to the embolized regions and resulting inflammation. Thankfully the lesion was biopsied as just inflammation but it can be a precursor to cancer which is why I am having another MRI next week to check on it after 2 years. Be VERY careful with multiple PAEs. I know what I am writing here. Howard