PAE — Upcoming Procedure 9/1/2021

I just scheduled a PAE with Dr. Clark, a Penn Interventional radiologist. Had the consult with him and PA last Friday. Thoughts at this point — 1. 73yo, history of heart disease and stroke. Am active, and in relatively good health now. 2. Had been to a PENN Urologist for 20 years. He suggested I check out PAE when symptoms got bad, mainly due to it doesn’t have any of the RE and ED side effects, recovery time is hopefully less than other surgeries, and less bleeding also. Current IPSS score = 25. 3. My prostate is big, MRI showed volume ~140ml (grams). Central gland enlargement was “severe”, I think that is the “median lobe”? 4. Dr. Clark is very active doing minimally invasive surgeries 4 days a week, and has excellent reviews at PENN. He has only done about 75 PAEs in the last 2-3 years, possibly a cause for concern, but after a Bagla and Isaacson interview on YouTube, I think it was one of them, or possibly the moderator, who said “Dr. Clark from PENN is the most talented IR he knows.” This coupled with wanting to stay, during Covid time, a few hours maximum from home, made my decision easier. He was also one of the very few to do PAE within a few hours from home. 5. He gave me the option of either radial or femoral incision, but added he has done almost all femoral. At 6’2” tall, I am going with femoral, even with the reported longer recovery. 6. No robots involved, he does the procedure along with possible intern helping. 7. Unilateral vs bilateral, he said that 75%+ are bilateral, even though the unilateral is nearly as successful. He measures successful as being 1/2 of the original IPSS score post procedure. 8. Patients have a 90% success rate. 9. Has a 100% rate of only hitting prostate arteries due to experience and 3D cone-beam. 10. Outpatient, non-surgical, about 1-2 hours procedure time, 3-5 hrs total, twilight. Will fill this in with the results in a month. Any thoughts, comments, are welcomed!

Autks.... I had PAE 7 weeks ago and I'm VERY satisfied with the results. My Prostate was a bit smaller than yours ( 105 cc with an enlarged median lobe) but certainly not small. IR told me that larger prostates like yours and mine usually have better results than smaller prostates. Procedure was painless and never had pain afterwards. The only side effect was extreme and unrelenting urgency for about 2 days but by day 5 or 6, I was already noticing a better flow than before PAE. Now at 7 weeks my flow is excellent. If you have any questions or concerns before or after I'd be happy to help.

Pete — that’s great that you had no pain, the extreme urgency for only few days would be a welcome cross to bear if it resulted in the same outcome as yours. How much did your IPSS score go down at week 7?

Good luck. It does work best on a large prostate....Ken

autks.. My IPSS score before PAE was 18 or 19 and now is 5 or 6. Very happy with that. Hopefully you will have similar results.

Ken -- the Urologist kept saying "it is only mildly enlarged" with the digit test. I was pretty happy, if you can call it that, how big it really was. Many thanks!

That sounds like it was not to big. When I had mine done it was double in size which is about 40 to 50 cc My prostate was close tight. He could not get the camera through to check bladder. First was put on Flomax. That pill sucks. Told my doctor I would not take it. Had the Urolift done 2 weeks later. It was only out 6 weeks when I had mine.

I'm still open. Only 4 clips....Just give yourself some time and see what happens

Good luck...Ken

hi autks, how are you feeling so far ? i did mine in canada and did not get any improvement at all. The doc did not have confidence in the procedure and i'm not surprised it didn't work.

l'm thinking of a second attempt if l get a good IR even in another country.

heard of somebody done a second PAE ?

Hi -- procedure is scheduled for Sept 1, 2021. Sorry to hear that yours was not successful. I have not talked to people having a 2nd PAE, but my doc says that requiring a 2nd procedure happens sometimes. offhand i forget why, but i think it has something to with embolizing the wrong prostate arteries. When did you have yours done?

From my research and conversations with 3 different IR's , the 2 main reasons for a 2nd PAE is the re-vascularzation of the prostate and not being able to embolize both sides of the prostate. Our bodies always try to correct anything it sees as wrong. When it sees that not enough blood is getting to the prostate, it grows new arteries to feed the prostate. When that happens, it starts to grow again requiring another PAE. If the IR is unable to embolize both sides of the prostate, a 2nd PAE may be necessary to try and get that side that was missed.

Pete -- my doctor says if they are able to successfully embolize both sides of the prostate they have not been needing to repeat the procedure, and if are unsuccessful on one side due to anatomy or spasm of the artery they can always try again at a later time if you symptoms still are bad. No mention of regrowth of arteries, though it does make sense that would happen. l wonder if in those regrowth of arteries it was simply a case of not getting them initially?

There is a recent post in this forum by someone who had a second PAE. However, in his case the first time worked really well, but 18 months later his symptoms were returning due to new arteries forming. His results after the second treatment were also very good.

This is probably not relevant to your situation since you did not respond well the first time.

I think Americans are so lucky to have access to these procedures. I'm so envious as a Canadian, when our urologists still push the ww2 designed Turp hacking....

They do a second one sometimes because the artery's grow back. PAE works best for larger prostate.

Take care...Ken

I'm so sorry for you but you should never give in to anything you don't agree with

Well there were a lot of factors. I had been wearing a catheter bag for 4 months, and was desperate to get my life back. And due to covid, I could'nt go to clinics in Montreal or Toronto because of the risk, when they were even open. So it was turp or nothing. Ottawa has 0 other options I'm afraid, and having paid 17000$ for a failed urolift I was ready to try this.

You had a bag for 4 months before you had the Urolift. Were you able to pee at all when you had the Urolift

Did your doctor tell you that if you were in retention a Urolift would not help you. You have to be able to pee before a Urolift.

I'm sorry but your doctor seams to have mess you up. I'm so sorry that he did this to you

It's important he uses cone beam (CBCT).

I had the PAE procedure yesterday at Penn-Presbyterian with Dr. Clark, IR.

Day 1 Went smoothly, about 1.5hrs procedure time, recovery time about 4hrs. Felt no pain during procedure. Bi-lateral, he did the main 2 arteries, left and right. I could urinate after PAE, even though a very small amount, doctors were not worried about retention. After release then it started, the sudden urgent need to urinate (thanks for the heads up Pete, but I now know what you meant.) But I had pain when I was urinating, and had to go again within about 5 minutes, over and over again. I got to the point where either I could not go, or just a few dribbles came out. I was worried about retention, and went to the ER where they did a bladder scan and temporarily inserted a straight catheter. Scan was negative for retention,, and they were only able to get maybe 50-60ml of urine with the cath, wow what a relief!

I believe the doctor should have stressed that the pain and urgency feeling was due to the prostate in a state of shock and inflamed. He did mention it a month ago, but apparently it did not sink in with me. Got ~1 hour sleep last night.

Day 2 Was better. Pain while urinating has subsided a fair amount, going quite a bit more than a few drops, and the drugs I took late the first day have kicked in. Going every ~15 mins, an improvement over 3-5min yesterday. Drugged up today also. Drove to the local market and back. Gently feeling around the groin area, nothing really stiff or sore. No hematoma, etc. I’m scheduled for tennis Friday, but think I’ll pass. He said that by day 4 or 5 I’ll be playing normal tennis, the gym, etc.

Will update again in a few days. Overall I feel pretty good 2 days after procedure.

Update -- Day 3 Noticed a mildly reduced need to urinate as often. Still taking LUTS drug for pain while urinating. Slept 1 hours straight thru last nite.

Day4 Terrible nights rest. Up to pee every 5-10 minutes. I think mainly due to inflammation, and hopefully not due to a UTI (taking heavy dose of antibiotics for possible UTI anyway.) Later in the day I noticed I was going more, and the frequency was less.

Day5 Much better sleep. Around 4 hours. Off of all meds today, including pain pills for LUTS, antibiotics, and inflammation. I went this AM for about 15sec with moderate stream, first time in a long while. Still have severe UTI “symptoms”, not really UTI, but just symptoms due to inflammation.

Day 6, Day 7 Mon + Tues Still have lessening symptoms. Sleeping better.

Day 8 and 9, Wednesday Thursday. Better sleep, less urgency, stronger stream, lower frequency. Overall much much fewer UTI symptoms. From day 5 with severe UTI symptoms, until day 9 with basically mild to no UTI symptoms. This PAE procedure appears to be working!!