I am having the PAE procedure on November 20th at Inova Hospital in Alexandria, VA. The procedure will be performed by Dr. Sterling. I asked Dr. Sterling if he trained or worked with Dr. Bagla when Bagla was at Inova. He cleared his throat and said "WE trained Dr. Bagla". I guess Bagla has the following but was not the first at Inova to do the procedure. Dr. Sterling said he used "Cone Beam Ct:" which allows him to precisely locate the location of the beads. I told him I have severe reactions to Prednisone and he said there was no problem and he would prescirbe other drugs post procedure. I will keep everyone up to date on my experience and results.
thanks for the information and good luck to you. keep us informed
Best of luck! Please let us know how it goes.
Do you have an enlarged median lobe?
Yes, my prostate is about 3X normal size. I have read all the post saying that PAE would not work with a prostate with a median lobe. I am not clear on why shutting off the blood flow to the prostate would be shrinking some parts and not others. Most of the literature I have read references prostate anatomy in "Zones" so I am still not clear on the distinction and how or if they relate. Hopefully with the Cone Beam CT, he will be able to locate the beads to be most effective. I chose PAE because if it does not work, I can always try another procedure. At least this procedure seems to have the least liklihood of adverse affects. I consulted with three Urologist besides the Interventional Radiologist prior to making a decision. Most of the old timer Urologist stick with the TURP. The last one I visited in Frederick, Maryland, a younger Dr., said "Yes, I think PAE is a good option for you to try". If it does work for me, then perhaps I can help debunk the "Median Lobe" mantra.
The PAE docs I've spoken to all say their results are much less effective when there is an enlarged median lobe. I'm sure that doesn't mean that it's never effective in such cases. Good luck!
How much will it cost and does your insurance cover it ? Hank
Good luck on the PAE. I had mine done 14 months ago by Dr. Isaacson at UNC. It has been a miracle for me and hopefully will be for you as well. Dr. Isaacson told me that when all the prostate lobes are enlarged they have great results. If only the median lobe is enlarged the procedure is not as effective. The first week post procedure was uncomfortable at times but I awoke on Day 8 and felt like a new person and slept all night without needing to urinate.
I also had my PAE w/ Dr. Isaacson. He told me something a little different. When there are enlarged median lobes, the rest of the prostate is also enlarged. The question is how large is the overall prostate. The larger the overall prostate is, the smaller percentage of it is made up of the median lobe. So, overall the results would be better when the ENTIRE prostate is large. When comparing a PAE of the same size overall w/ another the same size but w/ an enlarged median lobe - it is much less effective.
Please keep us informed of your results over the coming months.
Best of luck!
Ok, there is a lot of confusion (at least on my part) distinguishing "Lobes from Zones"
Here is what I found:
Name
Fraction of gland
Description
Peripheral zone (PZ)
Up to 70% in young men
The sub-capsular portion of the posterior aspect of the prostate gland that surrounds the distal urethra. From this portion of the gland ~70–80% of prostatic cancers originate.[13][14]
Central zone (CZ)
Approximately 25% normally
This zone surrounds the ejaculatory ducts. The central zone accounts for roughly 2.5% of prostate cancers; these cancers tend to be more aggressive and more likely to invade the seminal vesicles.[15]
Transition zone (TZ)
5% at puberty
~10–20% of prostate cancers originate in this zone. The transition zone surrounds the proximal urethra and is the region of the prostate gland that grows throughout life and causes the disease of benign prostatic enlargement. (2)[13][14]
Anterior fibro-muscular zone (or stroma)
Approximately 5%
This zone is usually devoid of glandular components, and composed only, as its name suggests, of muscle and fibrous tissue.
Lobes
The "lobe" classification is more often used in anatomy.The prostate is incompletely divided into five lobes:
Anterior lobe (or isthmus)
roughly corresponds to part of transitional zone
Posterior lobe
roughly corresponds to peripheral zone
Right & left Lateral lobes
span all zones
Median lobe (or middle lobe)
roughly corresponds to part of central zone
The Radiologist report on my 3T MRI says that my prostate measurements are:
5.9 cm in transverse diameter
4.9 cm in AP diameter
7 cm in SI diameter
Prostate Volume 89.7 cc
and states "The transitional zone is markedly enlarged and heterogeneous"
So, to me and the information above correlating lobes and zones, it seems as if my enlargement is in the "Anterior lobe or Isthmus"
Hope the above solves some of the anatomy confusion in case others are also having trouble distinguishing lobes from zones.
Paul
Thank for the info!
Medicare covers it and I also have supplimental insurance. I had hematuria associated with the BPH. I don't know if this is a qualifier for Medicare payment or not. Of course, after the fact there are often some things that are not covered by by both.
Dr. Bagla did my pae. I was told the same thing by dr sterlings staff at Inova. Then I forwarded the email to Dr. Bagla and he then cleared it up quickly. He did his fellowship there at Inova. When he was a fellow, they never did pae. Dr. Bagla learned on his own and alongside other IRs in other parts of the world. Dr sterling did NOT train Dr. Bagla in pae! When he left INova a few years ago, the the other doctors had done a total of 1 PAE alone compared with his hundreds. Dr Sterling is clearly using word majic to say he trained Dr. Bagla, but truth is he didn’t train him on pae as they never did it in 2007 when he was trained. Call Dr. Bagla to get an opinion at least bc the procedure was quick, 1/5 the radiation of what they do at Inova and he has more experience than anyone in the US
Hopefully you read the other post! Dr sterling did not train himself Bagla to do pae. They didn’t do pae until Dr. Bagla did it at Inova. Make sure you go to the best people for this! It can be risky if not done by experienced doctors
I had my PAE 25 months ago. Last week I sent my 3T MRI scan to Dr. Isaacson for his review of a possible cancer lesion. He took a look and called me and stated that he could not rule out that the area in question is not cancer so advise me to have the fusion biopsy, which I plan to do in Dec. He also stated that the scan shows that there is room for a lot of improvement to reduce my prostate. He took the time to explain why. If my biopsy indicates no cancer then I will have another PAE procedure with him next year sometime or 2019. The original procedure reduced my prostate by a little over 30 percent. It appears he is a little more aggressive in reducing the size of the prostate now, than he was 2 years ago. If I have cancer then that will have to be addressed before another PAE procedure can be done.
Hi Vig, did you have catheter on post op ? Hank
No, I did not have catheter post op. In hindsight, it may have helped. I can not take Prednison which is normally started a day before the procedure and therefore had to depend on Motrin for inflammation and pain control. I had a good amount of pain following the procedure for about a day and a half and then it suddenly went away. I had urinary frequency and burning with urination for about two weeks with it lessening during this interval. All of this was told to me in advance my Dr. Sterling. He said my symptoms would be worse for a couple weeks and then back to baseline symptoms prior to surgery and then improvement with most improvement during months two to three and then some further improvement until about the six month time after which there would be only minor improvement if any. I am now coming up on three weeks post procedure and I feel great. No more urgency or burning during urination and I can go most nights without getting up at all. So, after three weeks, I am happy I had the procedure done and any improvement from now on will just be icing on the cake for me as I feel very good at this point in time. I recommend anyone having the procedure done to have a urinal in the vehicle when you leave the hospital and wear a men's diaper for a couple weeks in case you do not get to the bathroom in time.
I know others on this forum have told me to use Dr. Bagla instead of Dr. Sterling because number of procedures but I had excellent experience with Dr. Sterling. This is not to say that Dr. Bagla is not excellent also. While true that Dr. Bagla did not specifically train under Dr. Sterling at Inova for the PAE procedure. Dr. Bagla served his fellow ship in Interventional Radiolgy under Dr. Sterling and others at Inova. I talked to nurses and professional staff at Inova who worked with both doctors and they all said that Dr. Bagla was a good doctor but decided to move on but they all said that they would not hesitate in any way to have Dr. Sterling treat their family members. In fact, there was sort of an unspoken preference for Dr. Sterling. May have been some political crap there that made Dr. Bagla decide to strike out on his own. Don't know for sure, just guessing, In any event. I do not hesitate to recommend Dr. Sterling.
Thanks Vig. Hank
Another success story. PAE should be the first choice for BPH issues involving prostates over 80 in size. With Medicare coverage, I believe this will grow dramatically. The medieval Urologists will be rarely needed.