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Posted 1/30/2013 8:30 PM (GMT 0)
Hi,
I just joined this forum and glad to learn a lot about the different treatments on BPH especially the embolization techniques. I'm also a firm believer of treating the root cause. I did contacted Gat Goren clinic last year but prohibited me from pursuing due to the cost involved. I'm just an engineering consultant and paying already a high premium on my private insurance. After doing research on different standard BPH procesures, i really got worried due to complications. I'm really contemplating to undergo this Gat Goren procedures as my BPH symptoms are not getting better. I'm an spiritual man and believes in prayers. I prayed that one day, I can find a solution for this condition. Just this morning, doing research on BPH treatments i stumbled a site owned by Inova Fairfax Hospital (703-504-7950) that uses Prostate Artery Embolization in clinical trials. I left a message and hopefully this is the answer for some of us. Let me know if some of you had undergone this clinical trial already and share your experience.
Regards
Posted 1/30/2013 9:53 PM (GMT 0)
From Inova Website:


Interventional Radiology
Conditions & Treatments
Our Team
Prostate Artery Embolization

Prostate artery embolization (PAE) is a new treatment option for men with benign prostatic hyperplasia (BPH), also known as an enlarged prostate gland. This procedure can greatly reduce BPH symptoms.

Most often, patients are discharged from the hospital 3 hours after the procedure, but sometimes it may be necessary to stay overnight.

If you have questions about this procedure, please contact us at 703-504-7950.


Clinical trial

Inova Alexandria Hospital is currently looking for patients for a clinical trial for PAE. Please contact us to see if you are a candidate.


Frequently asked questions


What are the most common symptoms of an enlarged prostate?

frequent urination at night
frequent urination that often produces only a small amount of urine
hesitant or interrupted urine stream
leaking or dribbling urine
sudden and urgent need to urinate
weak urine stream
feeling like the bladder is not completely empty after urinating
occasional pain when urinating
having to rush to the bathroom suddenly after the urge to urinate
sometimes complete obstruction when severe

Read more: Online health encyclopedia - Prostate Disease


When did prostate artery embolization for BPH start at Inova Alexandria Hospital?

In 2010, the Cardiovascular & Interventional Radiology Department became the first site in the US to begin a prospective IRB approved trial for Prostate Artery Embolization. The principal investigator is Interventional Radiologist Dr. Sandeep Bagla and Urologist investigator is Dr. Jeffrey Wong.

What can I expect during my evaluation for PAE?

Besides a history and physical examination, you will need to fill out a short questionnaire to evaluate the severity of your symptoms. After this, you will meet with the Interventional Radiologist who will discuss your treatment options and pre-procedure tests. Patients will also need referral to urology if they do not have an existing urologist.

What tests may be needed prior to having the procedure?

An MRI or ultrasound of the prostate may be ordered as well as a short test to evaluate the rate of urine flow. A blood test is needed to insure a safe procedure.

How is the procedure performed?

During the procedure, a small, spaghetti-like catheter is placed via an artery in the right groin into the arteries that supply the prostate. Very small particles are injected into the prostate arteries to decrease blood supply to the prostate, thus reducing its size and symptoms.

Will I need to stay overnight in the hospital?

Most often, patients are discharged from the hospital 3 hours after the procedure, but sometimes it may be necessary to stay overnight.

Will I need a foley catheter or catheter inserted via the penis?

It is routine practice to not place a catheter via the penis.

Do I need to have general anesthesia for the procedure?

Patients are given a sedative medication for the procedure which is similar to a colonoscopy and the patient usually is in a ‘twilight sleep.’ There is no need for general anesthesia. The procedure is not considered painful and some patients elect to have no sedation.

What are the results from the procedure so far?

Results are very promising with greater than 90% of patients seeing extreme improvement. Approximately 7% of patients see moderate improvement and 1-2% may see no improvement.

Can the procedure be repeated if my symptoms return?

Yes.
Posted 1/31/2013 5:42 AM (GMT 0)
Martin

So does it mean that a man can develop blood back-flow with high testerone concentration from testes in his 20th, then his prostate stay the same for another 30 years, and after that suddenly began to grow? I guess it is possible but there got to be another factor that triggers BPH after such long time. G/G don't give any explanation for that. It doesn't mean their procedure doesn't work, just that other factors exists they are not aware of.

Also I am wondering why there are no any follow up studies, no references to such on G/G website or in the publications. Everybody on this forum who had the procedure, done it recently. What happens after two or more years?
Posted 1/31/2013 1:19 PM (GMT 0)
>>> So does it mean that a man can develop blood back-flow with high testerone concentration from testes in his 20th, then his prostate stay the same for another 30 years, and after that suddenly began to grow?<<<

Sleepless...No!...BPH growth doesn't hibernate for 30 years. It's a gradual process. At one point in time, the man realizes his flow is slowing, and he has to get up at night to urinate.
Posted 2/1/2013 2:27 AM (GMT 0)
I'm following this thread with some interest. I had the GL laser 7 months ago, saw my symptoms return last month. My urologist found a membrane (scar tissue?) had grown in my prostate channel, nearly blocking it off, despite the fact that he had just removed about 60% of my prostate seven months ago (removed 70g. of a 120g. prostate).

What formed was a thin membrane so he removed it with the cystoscope, but said it was likely to return within 6 months. He suggested self catheterization once every two weeks to keep a new membrane from forming and re-attaching. At 66 I guess this is my best option for now.

It seems like the GG method or prostatic embolization would at least avoid the problem of scar tissue growing and blocking the channel. Even though statistically this is reported as about a 8% incidence with the turp and 6% with the GL, those stats were meaningless to me and others who had the side effect. While a 90% success rate sounds good, it's no guarantee of success.

I asked my urologist about the embolization and he was aware of the research but quoted the possibility of damage to the bladder, and rectum. Seems like there's "possibilities" of problems no matter what you do.

I don't expect any sort of meaningful studies to be released on the GG method or prostate artery embolization unless and until the procedure goes mainstream. In fact, the GL laser has been mainstream for about 8 years, with tens of thousands of procedures spanning the last 8 years, but it's difficult to find many statistics other than some studies showing a less than 10% failure rate. But if you are one of the 10%, or even the 1%, it really doesn't matter.

sleepless_in_seattle said...
Martin
......
Also I am wondering why there are no any follow up studies, no references to such on G/G website or in the publications. Everybody on this forum who had the procedure, done it recently. What happens after two or more years?

Posted 2/1/2013 4:55 AM (GMT 0)
Bob

I am sorry to hear about your problem. And you thought that GL is safe surgery. Well, even each complication has a low chance to occur, 1%, 5%, etc. the chance of having one of them is quite high. You had quite a large prostate. My urologists sugests open surgery, as my prostate is 4 times of normal size, and it is even more risky.

You mentioned your urologist was talking about possible complications of GG method, like possibility of damage to the bladder, and rectum. Was he talking about a catheter inserted in the groin in a wrong way?
I guess it is possible. What he thinks about its effectiveness?

I wish you speedy recovery.
Posted 2/1/2013 5:24 AM (GMT 0)
Martin

Prostate goes through fast growth phases: immediately after birth, at puberty, at 20th (all those are part of normal development) and at later stage 50th (our problem).

It is possible that infertile young man develop some back-flow, enough to cause infertility, but not for BPH. Later in life when valves deteriorate further they may develop BPH. The studies found infertile men twice likely develop PC, which confirms GG theory. I would love to know if men treated by GG for infertility developed BPH later.
Posted 2/1/2013 6:18 AM (GMT 0)
Prostate Artery Embolization

So are the clinical trials at Inova referring to the same techniques used by Gat Goren?

Is there any 'patent' problem here.

If Inova are doing clinical trials, this is a great step forward to acceptance of the procedure.
Posted 2/1/2013 6:31 AM (GMT 0)
sleepless_in_seattle Also I am wondering why there are no any follow up studies, no references to such on G/G website or in the publications. Everybody on this forum who had the procedure, done it recently. What happens after two or more years?

Almost from the beginning of this thread, questions have been bandied about about reading any hard core results. Gat Goren don't seem to have offered any publicly. One poster suggested that clinical trials were too expensive for Gat Goren.

My urologist was very tight mouthed about GG but I have accepted that if the Gat Goren method really is a breakthrough, urologists would try to obfuscate that because the procedure is much more in the realm of radiologists and specialists in blood vessels. But it still doesn't explain why blood vessel specialists are not promoting the procedure as it would be a great money generator. And. As I said in a previous post, GG have many reasons to have the procedure widely accepted as it would probably make them candidates for a Novel prize seeing as how many males past the age of 60 suffer from prostrate complaints.
Posted 2/1/2013 2:06 PM (GMT 0)
Per Claps question: >>>So are the clinical trials at INOVA referring to the same techniques as used by Gat Goren<<<

Great question. This could be very confusing.

From what I can ascertain, prostatic artery embolization (PAE) embolizes the prostatic artery. The Gat Goren technique scleroses (glues) the internal spermatic veins. Now whether the prostatic artery as defined by the Portuguese and INOVA is the same internal spermatic vein(s) as referred to by the Israelis...is a good question. Sclerosing or embolizing just shuts off a vein with different materials being used.

According to Gat:

"Free Testosterone arrives at the prostate not only physiologically via the PROSTATE ARTERY, but mainly via the prostate drainage system (the back door) carrying undiluted and yet unbound to sex hormone binding globulin (SHBG) and high concentrations of FT which bypasses the systemic circulation and is not detected in the peripheral blood."

http://www.touchbriefings.com/pdf/3344/gornish.pdf

Based upon Gat's reference, the prostatic artery is not the internal spermatic vein.
Posted 2/1/2013 4:24 PM (GMT 0)
martin victor - "Free Testosterone arrives at the prostate not only physiologically via the PROSTATE ARTERY, but mainly via the prostate drainage system (the back door) carrying undiluted and yet unbound to sex hormone binding globulin (SHBG) and high concentrations of FT which bypasses the systemic circulation and is not detected in the peripheral blood."

Does that mean that FT, (free testosterone) is continually circulating and causing damage???
Posted 2/1/2013 5:55 PM (GMT 0)
Clap...

YES!...Because the internal spermatic veins are compromised (valves are not working), hydrostatic pressure (which normally would push FT up) pushes the free testosterone back down into the prostatic drainage system causing hypertrophy (enlargement) and hyperplasia of the prostate (cellular change). The levels of free testosterone are estimated to be 120x what they normally should be. The Gat hypothesis is that such high levels could cause prostate cancer.
Posted 2/1/2013 6:25 PM (GMT 0)
Sleepless,

I think my urologist's practice is based on the GL, so his interest in any other procedure is limited. I guess it would be like asking a Chevy dealer what he thinks of the new Toyotas.
He didn't offer much opinion on the prostatic embolism method other than what I mentioned.
He knew about it but just offered a couple of negatives. I got the same sort of response from him when I asked about the button turp procedure that people on other forums said they thought was better than the GL. He offered a couple of negatives as a way of explaining that he thinks the GL is the best procedure.

I woke up feeling pretty good today. Only got up twice during the night. My stream is at about 30% to 40% of what I would call good, but I've been at 10%, 5% and 0% so I'm hoping it just stays this good. I plan to self cath every two weeks or so to keep the channel open. I guess I'll see how that goes.

I did and still have a large prostate. If a normal prostate is 25g. then mine was 5x normal and is still 2x normal. It seems, though that it's not the size of the prostate but the size of the channel that matters.

I went forward with the GL because it was done in the uro's office with IV twilight rather than general or spinal anesthesia in the hospital. It seems the GG or prostatic embolism procedures also have this advantage.

Also, Medicare covered all but a few hundred dollars. If my urologist offered another procedure I'd want to give it a try. Botox and Nymox injections also posted great results in trials. But none are offered mainstream at present.

Good luck in whatever decisions you make.

Bob

sleepless_in_seattle said...
Bob

I am sorry to hear about your problem. And you thought that GL is safe surgery. Well, even each complication has a low chance to occur, 1%, 5%, etc. the chance of having one of them is quite high. You had quite a large prostate. My urologists sugests open surgery, as my prostate is 4 times of normal size, and it is even more risky.

You mentioned your urologist was talking about possible complications of GG method, like possibility of damage to the bladder, and rectum. Was he talking about a catheter inserted in the groin in a wrong way?
I guess it is possible. What he thinks about its effectiveness?

I wish you speedy recovery.

Posted 2/2/2013 4:44 AM (GMT 0)
Bob

It's good to hear you are peeing well ;-) Let's hope it will heal ok. Are you taking any drags for that?

I would go through any procedure, doesn't matter what is involved, as soon as it works and doesn't cause serious complications.
Posted 2/2/2013 4:54 AM (GMT 0)
the major differences between PAE and GG methods: PAE deprives prostate from oxygen and nutriton by blocking artery that brings blood from heart, basically starving prostate. GG method, in theory, restores prostate normal environment, which was distorted by back-flow from testicles of blood rich with testerone.

I don't like the idea of "killing" prostate, unless one has PC. It is a useful organ. In that respect GG method is much better, if it works.
Posted 2/2/2013 4:32 PM (GMT 0)
sleepless...Thanks for the explanation. I was wondering if you starve the prostate of oxygen and nutrition, there is a greater chance for prostate cancer.
Posted 2/2/2013 4:47 PM (GMT 0)
Bob: >>> If a normal prostate is 25g. then mine was 5x normal<<<

According to Dr. Leventhal, an internist with the Gat team, they treated an 80 year old man with a prostate volume of 120. His prostate shrank to 40 and from 6 visits a night to the bathroom, he now only goes once. Dr. Leventhal is a Talmudic (religious) scholar...I would respect his opinion. What's interesting is that the testes which obviously hang outside the body, must be 3-4 degrees cooler than the normal body temperature of 98.6 degree F for sperm to live. Dr. Leventhal, upon my visit was able to immediately access my condition by measuring the temperature of my testes with a device made of thermal plastic. My temperature was the same as my body temperature which meant in all probability I had a varicosity in the Internal Spermatics...varicocelle. Seventy percent of men aged 70 do!. During the procedure, the radiologist confirmed my problem. The flouroscope screen showed blood from the internal spermatics were not supported by valves (blood dropped the length of the internal spermatics) thus concluding that the valves were compromised (not working).
Posted 2/2/2013 5:44 PM (GMT 0)
Sleepless,

Had one good night. Last night was back to about 3 seconds of stream and 45 seconds of dribbling. Got up a half dozen times during the night. Voided about 4 ounces each time (I use a calibrated disposable urinal so I can see how much I go by holding it up to the night light).

I have been taking generic flomax (Tamsulosin 0.4mg) daily for a couple of weeks, since the symptoms reappeared and I couldn't get a cath in. In a day or so I will start cathing myself periodically (I guess I'll find out what the frequency required is once I start ... and whether or not it works). The last couple of days I took the tamsulosin in the morning instead of after dinner, so maybe it wore off and that's why my flow was so diminshed by the evening.

Whether or not any procedure will work and to what extent seems like a mystery to me at this point. What are your present symptoms and what are you doing for them, if anything?

The thing that bothers me about all of this is that people assume that reducing the size of the prostate solves the problem. But this wasn't true for me. My prostate was reduced from 120g. to 50g. and it improved it my symptoms for just a few months. I am not in retention. I am no longer straining to pee a few tablespoons and having to cath myself to stop the pain. I am not storing large volumes of post void residual, so my bladder mouth seems to be working properly.

It seems all methods seem to work for a certain period from a few months to a few years. Some people get good results for several years, some get problems much sooner. GG says their method is a cure, and it might be, but no statistic can predict the outcome for an individual case. Even people who have their prostates removed for prostate cancer wind up having procedures to open up their urinary channels and bladder mouths after full prostatectomies.

I got a post on another forum from a person who seems to have gone through what I am going through. He had a membrane like mine cut away and an opening of the bladder mouth. Then a TUIP that lasted a year, then an old fashioned TURP that lasted 4 years, then a GL that lasted less than a year, then cathing himself weekly to keep the channel open (that's where I am at).
Finally he says he had a second old fashioned surgical TURP that has lasted seven years now. He said his last TURP has worked the best (not perfect, but good enough) and he will ask his uro what was done on the last TURP that made it work better than all the rest.

Like all methods, the GG will work for some percentage of people for some length of time. Even they haven't claimed 100% success. Their theories sound good, but still rely on reduction of prostate size. I presently don't see the model of prostate reduction creating a good urine stream / bladder emptying explaining my own recurring problem of a reduced channel just 6 months after a GL and now two days after cutting away a blocking membrane. Something else is at play here, that I haven't got a satisfactory explanation for yet. Still searching for "the answer".

Bob

sleepless_in_seattle said...
Bob

It's good to hear you are peeing well ;-) Let's hope it will heal ok. Are you taking any drags for that?

I would go through any procedure, doesn't matter what is involved, as soon as it works and doesn't cause serious complications.

Post Edited (Bob_NJ) : 2/2/2013 10:47:21 AM (GMT-7)

Posted 2/3/2013 12:19 AM (GMT 0)
As i understand from the radiologists point of view the artery embolization is a 20 minute procedure, that is probably very easy for an interventional radiologist to learn. Moreover if it proves successful it is likely that urologists will learn the method, as they would hate to hand over their bread and butter to radiologists.

GG is rather involved long procedure, that might not be easy to learn for In. Rad. either and they might not see it as good business if they do not get uro referral and might not get sufficient compensation for doing the procedure.

-----
The advertisement claims that the embolization will not destroy the prostate or its function only decrease the size. I beleive they claim ejaculation is still there after the procedure and a patient became father after the procedure. I doubt that they can really fine tune it.
-----

Anybody knows whether cancer is an exclusion criteria for the INOVA PAE trial?
Posted 2/3/2013 2:12 AM (GMT 0)
I have cancelled my scheduled GL BPH surgery two weeks ago. My story is similar to Jimbeliever's.

Based on GG theory I started experimenting with testosterone supplementation to improve my BPH symptoms..
The theory is that my prostate would get somewhat more testosterone from the serum testosterone through the artery. On the other my body's testosterone production would be reduced to close to 0. (That is well known. the pituitary gland would stop producing LH and thus the testis would stop producing testosterone.)Now if GG is right then the most important factor is the intraprostetic testosterone level, and in case of BPH the overwhelming amount of this is coming through the backroom leakage from the testis. So the overall effect even with the elevated serum testosterone should be a very significant reduction in the testosterone level in the prostate.
Anybody has any opinion?

I have been doing this for about a week. It looks promising but way too early to tell.
Posted 2/3/2013 7:17 PM (GMT 0)

martin victor said...
sleepless...Thanks for the explanation. I was wondering if you starve the prostate of oxygen and nutrition, there is a greater chance for prostate cancer.


No. Tumor needs oxygen and nutrition to grow.
Posted 2/3/2013 7:45 PM (GMT 0)
According to GG even very low testerone level produced by testicles would provide enough back-flow to cause prostate growth.

mikebph said...
I have cancelled my scheduled GL BPH surgery two weeks ago. My story is similar to Jimbeliever's.

Based on GG theory I started experimenting with testosterone supplementation to improve my BPH symptoms..
The theory is that my prostate would get somewhat more testosterone from the serum testosterone through the artery. On the other my body's testosterone production would be reduced to close to 0. (That is well known. the pituitary gland would stop producing LH and thus the testis would stop producing testosterone.)Now if GG is right then the most important factor is the intraprostetic testosterone level, and in case of BPH the overwhelming amount of this is coming through the backroom leakage from the testis. So the overall effect even with the elevated serum testosterone should be a very significant reduction in the testosterone level in the prostate.
Anybody has any opinion?

I have been doing this for about a week. It looks promising but way too early to tell.

Posted 2/3/2013 8:00 PM (GMT 0)
Bob

prostate size does matter, we all know that. Yo problem, as of many others, is scar tissues that develop after any invasive procedure. GG doesn't invade prostate and won't cause such complications. The BIG question: if their method works. They claim 300 procedures with high success rate (whatever it means). But there is no independent verification or published results.

Bob_NJ said...
Sleepless,

Had one good night. Last night was back to about 3 seconds of stream and 45 seconds of dribbling. Got up a half dozen times during the night. Voided about 4 ounces each time (I use a calibrated disposable urinal so I can see how much I go by holding it up to the night light).

I have been taking generic flomax (Tamsulosin 0.4mg) daily for a couple of weeks, since the symptoms reappeared and I couldn't get a cath in. In a day or so I will start cathing myself periodically (I guess I'll find out what the frequency required is once I start ... and whether or not it works). The last couple of days I took the tamsulosin in the morning instead of after dinner, so maybe it wore off and that's why my flow was so diminshed by the evening.

Whether or not any procedure will work and to what extent seems like a mystery to me at this point. What are your present symptoms and what are you doing for them, if anything?

The thing that bothers me about all of this is that people assume that reducing the size of the prostate solves the problem. But this wasn't true for me. My prostate was reduced from 120g. to 50g. and it improved it my symptoms for just a few months. I am not in retention. I am no longer straining to pee a few tablespoons and having to cath myself to stop the pain. I am not storing large volumes of post void residual, so my bladder mouth seems to be working properly.

It seems all methods seem to work for a certain period from a few months to a few years. Some people get good results for several years, some get problems much sooner. GG says their method is a cure, and it might be, but no statistic can predict the outcome for an individual case. Even people who have their prostates removed for prostate cancer wind up having procedures to open up their urinary channels and bladder mouths after full prostatectomies.

I got a post on another forum from a person who seems to have gone through what I am going through. He had a membrane like mine cut away and an opening of the bladder mouth. Then a TUIP that lasted a year, then an old fashioned TURP that lasted 4 years, then a GL that lasted less than a year, then cathing himself weekly to keep the channel open (that's where I am at).
Finally he says he had a second old fashioned surgical TURP that has lasted seven years now. He said his last TURP has worked the best (not perfect, but good enough) and he will ask his uro what was done on the last TURP that made it work better than all the rest.

Like all methods, the GG will work for some percentage of people for some length of time. Even they haven't claimed 100% success. Their theories sound good, but still rely on reduction of prostate size. I presently don't see the model of prostate reduction creating a good urine stream / bladder emptying explaining my own recurring problem of a reduced channel just 6 months after a GL and now two days after cutting away a blocking membrane. Something else is at play here, that I haven't got a satisfactory explanation for yet. Still searching for "the answer".

Bob

sleepless_in_seattle said...
Bob

It's good to hear you are peeing well ;-) Let's hope it will heal ok. Are you taking any drags for that?

I would go through any procedure, doesn't matter what is involved, as soon as it works and doesn't cause serious complications.

Posted 2/3/2013 11:39 PM (GMT 0)
Sleepless: >>>They claim 300 procedures with high success rate (whatever it means). But there is no independent verification or published results. <<<

Journal of Andrology: P.277. Prostate Volume , PSA and Nocturia before and after the treatment of 28 patients with BPH:

AVERAGES:

Volume Before Treatment: 56cc After Treatment: 36.93 cc

Nocturia Before Treatment: 3.89 After Treatment: 0.89

PSA Before Treatment 3.9 After Treatment: 3.4

Above includes research from Patent
Posted 2/3/2013 11:46 PM (GMT 0)
Sleepless: From Science Daily: Cancer can survive without oxygen.

"Some cancer cells similarly adapt; as a tumor grows too big for its blood and oxygen supply, some cells transform so they can survive without oxygen, emerging stronger and treatment resistant, says Dr. Zheng Dong, cell biologist.

He doubts that these two very different cell types travel the identical road to survival. "But the final result is the same," he says. "They simply become stronger, tougher and more resistant to injury, and for those in tumors, more resistant to cancer therapies."

The researcher, whose latest findings are featured in recent issues of the Journal of Biological Chemistry and American Journal of Pathology, is tracing the steps each takes, ultimately to see whether cells that would be lost to stroke and heart attack can be made equally durable – and, possibly, whether cancer cells can be made vulnerable."
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