NEW! Gat Goren, Part 4. Now with PAE and LUTS!

Hi Geoffz,
If I had the PAE to do over again, I'd do it. And, I would have no reason at all not to use Dr. Bagla.
They are great folks.

I thought there were 1 or 2 other guys on here that had it, but I could be mistaken.

PAE.... easy procedure. easy recovery. covered by my insurance. easy choice.

From Jan 25, 2014 Journal of Vascular and Interventional Radiology: 47-52

Bagla S et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia.

The clinical trial involved 20 men with BPH who underwent prostatic artery embolization (PAE) between January 2012 and March 2013. Prostatic artery embolization is an invasive but nonsurgical procedure that does not require anesthesia and can be performed on an outpatient basis.

During the procedure, a catheter is threaded into an artery in the patient’s leg until it reaches the artery that provides blood to the prostate. At that time, the clinician injects minute beads into the catheter so they will temporarily block the flow of blood to the enlarged gland. The stoppage of blood allows the prostate to shrink and thus provides symptom relief.

In the clinical trial, prostatic artery embolization for prostatic benign hyperplasia was technically successful in 18 of the 20 patients, while bilateral PAE was successful in 18 of 19. The lack of success was due to the presence of atherosclerotic occlusion; that is, the buildup of plaque in the prostatic arteries.

Here is a breakdown of the clinical trial results:

American Urological Association symptom scores improved 10.8 points at 1 month, 12.1 points at 3 months, and 9.8 points at 6 months

Sexual function improved by 34 percent after 1 month, 5 percent at 3 months, and 16 percent at 6 months

There was an 18 percent decrease in prostate volume at 6 months

Quality of life improved over the 6-month follow-up period

Patients did not report any minor or major complications. This is in contrast to other BPH treatments. Some of the side effects of treatments for BPH include erectile dysfunction, temporary urinary incontinence, blood in the urine, and retrograde ejaculation, among others.

The authors concluded that these early results suggest prostatic artery embolization for benign prostatic hyperplasia is both safe and effective as a treatment option for men with this common prostate condition
In an earlier study of PAE, which was originally developed at the University of Sao Paulo Medical School, researchers tested the procedure on 11 men with BPH who had not responded to alpha-blockers. In that trial of prostatic artery embolization for benign prostatic hyperplasia, prostate reduction averaged 30 percent and 10 of the 11 men experienced symptom relief. The one remaining patient experienced reduction of the prostate of only 5 percent and was ultimately referred for a transurethral resection of the prostate (TURP) after two unsuccessful PAEs.

Overall, prostatic artery embolization for benign prostatic hyperplasia appears to be a safe and effective BPH treatment. Men with BPH may soon have this procedure as a therapeutic option.

Michael Daner said...
Am I missing something? Seems there is an 18% reduction in prostate size. Does that seem like enough?

The devil is in the details. If you read the whole study you will find that the study was only 20 patients receiving PAE including one with a 274 mm prostate. At 6 months only 5 patients were still included in the study. The rest were excluded for various reasons. So the results are based on 5 patients who were not excluded from the study after treatment. Statistically, there's no validity to these findings. That's too small of a sample to be used as a predictor of outcomes at large. And the people who weren't excluded may have been those with with the best outcomes. There's no way to tell.

Also the AUA scores were reported as lowered 10 points but were still at 21 +/-5 after 6 months. A score of 20 is considered severe symptoms and a score of 8 to 19 is considered moderate symptoms of bph. So everyone in the study still had severe to moderate symptoms of bph LUTS 6 months after the PAE.

Statistics was by far the most valuable subject I learned in school, and forever changed the way I looked at life. The way medical studies report statistics in general are a misdirection, but if the details are available, and knowing what a statistically valid sample is and the difference between relative and absolute results, you can get a true picture.

The difference between reporting relative and absolute results is the way most pharmaceutical studies are misleading, even when the sample size is statistically large enough to be relevant. For example, you sometimes hear of pharmaceutical trials reporting a 50% decrease in risk of heart attack or stroke with a certain medication. That's an example of relative results. If you look at the study details you find that there was 1/10 of one percent incidence of heart attacks or strokes without the medication and a 1/5 of one percent incidence with the medication. Those are absolute results. So it's true the relative risk was halved, but the absolute risk (lowered from one in a thousand to one in 500) was insignificant to begin with. But people think that halving their risk of a heart attack or stroke is important, so they buy the drug, not realizing their chance of having a heart attack or stroke themselves are essentially the same with or without the drug.

Post Edited (Bob_NJ) : 1/31/2014 2:36:09 PM (GMT-7)

Bob, thanks for going to the trouble of locating and reading the paper. All us lazy folks are in your debt!

A sample size of 5 is less than ideal, to say the least.

By the way, do you mind if I ask you about some typos in your overview? For "274 mm" do you mean "274 grams" or "274 cc"? Also, I think you reversed "1/5" and "1/10". And instead of "(lowered from one in a thousand to one in 500)" meant "(lowered from one in 500 to one in a thousand)". Or flip the text description surrounding these. I'm not throwing stones here, as I commit more typos than anyone.

You had some really good points to make.

BTW, since we're on the subject of AUA symptom scores...My own score declined from 25 before the procedure to about 7 or 8 now, 2.5 years later. I was totally miserable back then. That "before" score was on 8 mg Rapaflo/day, and the "after" score is on *no* Rx drugs at all, just some arginine. (I take 3 grams a day in two divided doses of 1.5 grams with food--I don't want to risk any new problems.)

Dave: Why so much arginine? I read it helps shrink the prostate and is better than Viagra for erectile problems which many of us face as we get older. Do you feel 3 grams a day has helped you? Thank you.

Nosheds,

I hope you will forget your promise not to update. I am interested in what your symptoms of bph are.
Without knowing what your starting point is, there's no way for forum readers to evaluate what progress was or wasn't made by your GG procedure. What improvements are you expecting or hoping for?

Bob

nosheds said...
updating a non event: I am 5 weeks after my GG procedure and no improvement so far (well, nobody expects S.I. and neither a super quick improvement). promise not to update again until there is an improvement.

Nosheds, I am also very interested in what your sx were before the GG procedure. Also, how did you respond to Flomax/Rapaflo/etc prior to the procedure. I am getting a very good response to Flomax (but zero libido) and wonder if that might be a predictor of success with the GG.

By the way, does anyone know if GG also knock out the deferential vein running from the pampiniform plexus to the vesicular vein (thus directly knocking out the flow of testosterone-rich blood to the prostate)? This might not be needed if sclerosing the ISMs already reduced the hydrostatic pressure but might be an additional guarantee.

Hi Nosheds!

Thanks for posting your baseline symptoms. Now we can sit back and track your progress over the coming months and (gulp!) years. I noticed my first improvement 3.5 months post-procedure, and my final improvement 21 months afterwards.

Following cases such as yours "prospectively" is a less biased approach than following post-hoc successes like mine. I didn't post until two years after the procedure, when I was certain that it had achieved good and sustainable results. There's always the problem of "reporting bias" in cases like mine: Maybe just the successes post their results on this thread. Which in my case is probably true. If I hadn't got good results, I probably would not have posted at all. With prospective cases, this is less of a worry (except for any drop outs).

I think there are a few others getting the procedure done about now. I would encourage ALL of you to introduce yourselves, if you haven't already done so. Please post your baselines now so we can track your progress prospectively too. NOTE: Baselines can also include mood and testosterone levels if those are issues for you.

Post Edited (Chicago Dave) : 2/2/2014 1:28:29 PM (GMT-7)

>>> Frank - I can offer a guess: G and G seal each and every vein draining the prostate. leaving even one open defeats the entire deal.<<<

I don't believe this is the case. To my knowledge the seal is only the ISV veins up to the point where they bypass the Common iliac and not into the pampiniform plexus. Testosterone now flows from three areas eventually making its way into the inferior vena cava. These three areas are the deferential vein, the scrotal vein and the cremasteric vein. So to answer your question the deferential vein remains intact. I had the procedure and was concerned what pathways testosterone would take if the internal spermatics were glued. And by the way, my libido is super high, along with my testosterone levels given my age of 71. I wish I could say that my urgency, and frequency has also improved after 18 months. I believe the Gat procedure along with PAE has its place as a better alternative to TURP or the other crude surgical interventions. But I am not convinced that Dr. GAT has the answer. Perhaps failure of the ISV values are more of an indication and symptom of inflammation than the cause of BPH. The cause can be multi-focal including diet, excess **********, prostatitis, hormone imbalance etc.

Consider that only about a third of men with an enlarged prostate get progressively worse and need treatment. Also consider that women get the same problems of frequency and urgency and burning and they have no prostate. I've read millions of men and women have LUTS (lower urinary tract symptoms, also called prostatism in men) with no detectable cause or treatment options. All the treatment options seem on the order of, try this, and if things don't improve sufficiently we will try something else.

Bob

Dr. Gat's theory is that all mammals except man have horizontal ISV's. They don't get BPH. During evolution, when hominids went from walking on all fours to just two legs, there was increased pressure or gravity on the internal spermatics which eventually resulted in the failure of the valves. An indication of this is the belief that taller people have earlier symptoms of BPH than shorter people given the greater length of their ISV's. I think this is an interesting theory but much to simple an explanation. Orientals have less prostate problems than Americans, but it is probably more a function of their diet, culture, lifestyle rather than height.

Hi I have just joined the site.

I have been reading all the details from thread 1 and just finished 5 taken a few weeks, phew!

Anyway my main problem is frequently having to pee and a few years ago I used to get up about 5 to 6 times a night, it was very waring! I originally saw a women specialist under BUPA ( I am in UK) and she just wanted me to have a TURPS. As I had previously read about all the problems I told her I wasn't happy with that, so she eventually agreed to put me on Flowmax. Due to her very aggrogant attitude, won't go into that now, I complained and I went to see another Urologist who was much better.
The flowmax didn't really work for me so he put me on a new combination drug that had recently been approved. At first I must have had every side effect going, but I persevered and after a few months it started to work. The only problem being I had quite a few retrograde ejaculations, which to me were awful, plus I quite often had trouble with erections, so I came off them and tried some tablets from SimplySupplements called Prostaform plus. After a few weeks they were working just as good as the perscribed tablets with no side effects, apart from still had trouble sometimes with erections, which I blame on the perscription meds!

I have been using these for quite a few years now, but my greater frequency symptoms have started to appear again, so thats when I came across your post, when looking for a new solution.

Both the GG and PAE seem to look quite good, but for me its the cost.
I noticed in one of the replys someone mention Urolift, so I also looked into that option.

Last week I saw my Urologist again, now under the NHS as I don't have BUPA anymore which he agreed two years ago that I could still see him via NHS, which was very kind of him. As I had found out from someone that he was going to leave later this year I thought I would mentioned the GG, PAE to him, as he would proberly be more open about it! On questioning him, he told me hadn't heard of either, but when I mentioned about this new procedure Urolift he told me he knew the surgeon very well who had brought it to the UK. He explained to me how it worked and that there would be no problems or side effects as with TURPS etc and that if I wanted he would write to his friend and see if I could get it under the NHS, which I agreed.

I now have a follow up appointment in three months presumingly to advise if I can have the Urolift under the NHS. As the cost is approx £7,500, I can't really see me getting it for free under the NHS, even though they are apparently trialing it!

I know the Urolift method hasn't really been mentioned much on this post, but as another alternative, has anyone any had this procedure or know anyone who has had this done?

Hi Frank!

Thanks for filling us in. I was wondering what was happening with you.

I'm going to keep you company watching the progress our folks make over the next few months and longer. As a hobby, it's almost as exciting as Bonsai gardening.

Hey you lurkers out there: C'mon and post if you're getting either GG or PAE (or other) so we can track your progress!

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Hi Chumley from across the pond!

We'd love to read some first-person accounts about the Urolift procedures and such on this thread. But I don't think we have it over here in the States. (Correct me if I'm wrong, guys.). It probably would need FDA approval first, which can take a while.