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Gat Goren, PAE, LUTS, Part 7

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Posted 10/6/2015 2:18 PM (GMT 0)
Reminder: The running list of progress reports is on page 2 of this forum. I usually update it whenever there's a new development.
Posted 10/7/2015 3:03 AM (GMT 0)
PAE vs GG/Varicocele? Not a lot of data available to evaluate for treating BPH. I went the varicocele route since it was readily available, relatively noninvasive, and covered by insurance for me. I would much rather have a catheter threaded through a vein than an artery. On the other hand, PAE seems to provide symptom improvement faster. We don't have recurrence data for either procedure, but I would guess there is a higher probability to need repeat PAE vs repeat varicocele. The body is pretty good at growing a new blood supply to damaged areas. If the GG theory is correct, PAE doesn't correct the underlying problem causing an enlarged prostate (the flow of testosterone directly from the testicle to the prostate). Maybe have both procedures done simultaneously? ...for immediate and long term relief? Not that you could talk any radiologist into doing that.
Posted 10/7/2015 11:42 AM (GMT 0)
Frank,
Just curious. Why would you rather have a catheter threaded through a vein as opposed to an artery? Seems like an artery being wider would be easier. I think you made a great move getting the Varicocele. I'm convinced it's the same thing as the GG…on a budget!

Dave,
I didn't realize you had those testosterone improvements. That would seem to back the GG theories.
Would love to have lunch but I actually was thinking about Dr Bagla at Innova in Virginia. Seems like he's done the most operations and is a big researcher as well. I had it scheduled with him and then called it off. I'm doing CIC and waiting for possible improvements in PAE or Varicocele. As mentioned, I'm concerned about the radiation and contrast dies.
Since I'm in pretty good shape now post Urolift, using tamsulosin and night time cathing, pretty much all my symptoms are gone. Of course I still have about 300 ml of retention which I'd like to reduce and I'd love to eliminate the Tamsulosin and stop cathing. But for now it works and compared to not having my bladder work at all I'm currently a very happy camper.
PS Been reading about CIC on Patient.com. (under subject Self Catherization) One guy shrunk his bladder to virtually no residual urine without any operation.
(CIC stands for Clean Intermittent Catherization)
Posted 10/7/2015 11:54 AM (GMT 0)
Going into a vein is considerably easier & much safer - when my Varicocele was done the radiologist went in up by my neck, I could watch the whole procedure on the screen myself. For PAE they go into arteries around your groin & might have to use 2 entry points - if you have a bleed with an artery that is much much more serious & in fact the whole procedure is considerably more complicated. That's why it costs more.
Posted 10/7/2015 8:52 PM (GMT 0)
Thanks Peter. That makes sense.
Posted 10/8/2015 12:53 AM (GMT 0)
UPDATE: I'm feeling pretty good. it is now 27 months since my ISV embolization and 14 months since my P A E and 6 weeks since my last
dose of any medication. my bladder capacity is slowly increasing toward normal, although it is on average 6 ounces so I can get about 3 hours of sleep at a time. this is my personal best for the past seven years.
anyone with medicare can get both of these procedures;I can explain how if anyone is interested.
Posted 10/8/2015 6:52 AM (GMT 0)
Zoesman, Did you gain any benefit from the ISV embolization? You waited a long time before your PAE which you must have decided on as you're symptoms must still have been intolerable.
I've had ISV (aprox 8 moths ago) & am thinking of revisiting it to see if there are any collaterals which could/should be shut down. I've asked my Interventional Radiologist what he thinks & am waiting for a reply.
Thanks, Peter. (UK)
Posted 10/8/2015 10:14 AM (GMT 0)
Peter, there appeared to be some improvement afters ISVE from about 1 mo to 6 mo. although medication was always required. then the LUTS increased to every 15 to 20 minutes so I spent alot
of time at night reading about P A E .
I cannot imagine how the I R could now access untreated collaterals
since I believe they are reached via the ISVs before they are sealed off.
Posted 10/10/2015 12:24 PM (GMT 0)
It seems that folks on here have generally seen much, much faster improvement with the PAE than with the GG.
PAE fixes the problem by directly limiting blood supply. GG works on the supposed source of the problem, too much Testosterone bathing the prostate and takes much longer. (PAE 2 months as opposed to GG 1+ years).

I wish that I was just getting into this problem now rather than 2 years ago.
I would have had my radiologist do the PAE and the variocele procedure at the same time.... if he would.

There is no need to travel to florida or most anywhere else for the variocele procedure. There are numerous docs that do this in basically every state. Quite a few in Mississippi.

I am doing well now post-PAE, but still have occasional flare-ups.
I can't drink coffee at all. not even one cup. Tea is a no-go also. I can drink 1 soft drink each day. If I go above this I will have complete close-off and have to cath.

I still have a little residual volume, about 100-120cc per night and have to take cipro occasionally to keep my urine clean.

I have bi-lateral varioceles with some amount of discomfort. Been talking to my uro about it.
He is skeptical about this procedure helping my prostate, as he was with the PAE, but is helpful and very supportive. He also said it might not even help the mild scrotal pain in general nor the right side scrotal pain when I urinate.
He is a PAE believer now because of my situation. (Mine was really bad prior to PAE at age 50 then)
He wants me to wait until Spring to see how much more I improve. He plans an MRI and, if no more improvement, then his recommendation of "his guy" that does the most variocele repairs in Mississippi.

In the Spring, I may be the first guy to have had both procedures. Lucky me! turn
That last sentence was sarcastic in case you have no sarcasm awareness. lol.
Posted 10/10/2015 12:28 PM (GMT 0)
Also, I was able to get off Proscar with it's awful side effects and am now feeling much better. I want to get off flomax and cialis and be prostate/bladder "drug free".
Unless something else is done, that won't happen..... it seems.
The only other option, that I see, is bladder neck procedure which has a high incidence of Retrograde ejaculation. no thanks.
Posted 10/10/2015 5:28 PM (GMT 0)
1rphguy--

I've updated the running list with your latest report. Thanks for that.

It's my impression, too, that PAE works faster than GG, for the reasons you give. At least that's the impression I get from reading this forum and Patient.co.uk. Also, I think that PAE and GG have different ideal patient populations. There are reports of PAE for patients with very advanced BPH conditions who are even catheterizing themselves, but I've never heard of GG for such patients. In my non-professional opinion, I've always viewed GG as fundamentally a *preventative* procedure, that fortunately works on advanced cases with symptoms. It's only when the symptoms get bad that a prostate condition is given a name such as BPH.

BTW, it is easy to convince me that GG is simply a refinement of an existing procedure used to treat varicoceles. But that doesn't convince me that the two procedures have the same success rate in the clinic. Sometimes, small differences are meaningful. I'm still waiting for someone to investigate this issue in detail and report back to the forum on his findings.

Good luck to all making this journey.
Posted 10/30/2015 4:50 PM (GMT 0)
Hi Guys,

Someone on Patient.com posted information on a summary of recent study of many of the current minimally invasive therapies. It was by Fouad Aoun on minimally invasive devices. Put that in a search and you'll find it.
Pretty up to date. What intrigued me there was mentions of the PEMF therapy. It was not prominently featured but it got me to an animal and human studies using some of the footnotes and a couple of mentions in the main article. Seems like the Parsemus Foundation funds studies of minimally invasive overlooked therapies and they funded one on Pulsed Electromagnetic Fields on dogs prostates and it resulted in a 57% reduction in size with absolutely no side effects. There have been previously published human studies. This is a therapy used to mend bones and other current applications. I'm using Clean Intermittent Catherization while waiting for this type of really minimally invasive therapy.
Posted 10/31/2015 8:28 PM (GMT 0)
Thanks for the link Michael

Well worth a read.
The Rezum system looks interesting although trials won't be completed until 2019.
Posted 11/2/2015 3:55 PM (GMT 0)
FYI found these links

http://www.parsemusfoundation.org/new-treatment-for-enlarged-prostate/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145661/


http://www.prnewswire.com/news-releases/nxthera-receives-510k-clearance-for-rezum-system-to-improve-lives-of-men-suffering-from-symptoms-associated-with-benign-prostate-hyperplasia-bph-300137015.html

Post Edited (Jeff@57) : 11/2/2015 12:27:10 PM (GMT-7)

Posted 11/4/2015 12:30 AM (GMT 0)
Michael, Jeff...Thanks for the great research. Maybe some desperate people who urinate 5x a night might not wish to wait until 2019 for FDA approval. I imagine if it works on dogs there is a good probability it will work on humans. ...57% reduction in size is incredible. We are the vanguard. Any volunteers?...just follow the protocol used in the ncbi research report mentioned by Jeff. I can dream of No turps, no invasive procedures,... millions of elderly men with a hand held instrument using electromagnetic energy to reduce their size of their prostates in a few weeks.... and urologists seeking a new specialty for lack of business. Nirvana!! Just follow the protocol as described in http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145661/

"Can electromagnetic field therapy treat prostate enlargement in humans?

http://www.thehealthsite.com/news/can-electromagnetic-field-therapy-treat-prostate-enlargement-in-humans/
Shraddha Rupavate Jun 25, 2014 at 10:27 am

Prostate cancerIn a new study published in the journal The Prostate, a new non-invasive method called pulsed electromagnetic field therapy (PEMF) was found to be effective in reducing the size of prostate gland in dogs with benign prostatic hyperplasia (BPH) or age-related enlargement of the prostate gland. The study authors suggest that the method could be relevant for use in humans as well.
The study was carried out on 20 dogs with BPH and a Magcell Vetri device from Physiomed Elektromedizin AG, Germany. They were provided PEMF treatment for 5 minutes, twice a day for three weeks. The device was simply held over the skin where the prostate is located. An average 57 per cent reduction in the size of the prostate resulted in just three weeks, which is a remarkable improvement. No interference with semen quality, testosterone levels or libido was observed. The idea of using this method for BPH is to improve prostate blood flow and reduce the size of the prostate gland.
Posted 11/4/2015 12:48 AM (GMT 0)
Pulsed Electro-Magnetic Field Therapy - PEMF

http://www.electro-magnetic-therapy.com

When looking for a PEMF device it is imperative that the device has the ability to penetrate the human body. As you move away from a PEMF pad the pulsed electromagnetic fields decrease substantially. Many devices are not strong enough to penetrate the entire body.

Curatron PEMF systems offer full body penetration with superior speed of induction and changing frequencies to avoid body adaptation. Curatron also carries high-energy coils for concentrated treatment between 45,000 micro Tesla and 160,000 micro Tesla.

PEMF therapy is based on more than 30 years of worldwide research carried out by renowned scientists and many years of practical experience by thousands of doctors, chiropractors and therapists. Millions of treatments have already been successfully done with Curatron PEMF systems, in more than 80 countries worldwide, improving dramatically the quality of life for numerous people!

Curatron PEMF therapy is very successful for pain relief, as well as for many other conditions.

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Stress reduction
Health and Fitness
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Athletic Performance
Pulsed Electro Magnetic Fields influence cell behavior by inducing electrical changes around and within the cell. Improved blood supply increases the oxygen pressure, activating and regenerating cells. Improved calcium transport increases absorption of calcium in bones and improves the quality of cartilage in joints, decreasing pain dramatically. Acute and even chronic pain, also caused by arthritis and osteoporosis, may disappear completely.

There are many scientific studies on the degree of effectiveness for pulsed electromagnetic fields therapy. It was found that disturbances in blood circulation and in metabolism play a key role in the development of diseases. Application of PEMF therapy, also called energy medicine, by pulsed electromagnetic fields with Curatron devices has a proven track record for more than 15 years.

The Curatron systems are the only computerized systems using advanced Frequency Modulated Pulsed Electro Magnetic Field therapy (FM-PEMF). This technology generates time variable, low frequency pulsed electromagnetic fields, which are far superior to other PEMF technologies.
The Curatron systems are the only economical priced computerized PEMF systems generating sufficient energy to obtain a real therapeutic effect.

The excellence of the Curatron systems has made Curatronic Ltd. the undisputed leader of PEMF therapy devices on more than 5 continents around the world.

Curatronic keeps overhead and profit margins as low as possible in order to offer the best PEMF therapy devices in the market, to as many people as possible!
Posted 11/4/2015 12:55 AM (GMT 0)
Magcell Vetri used in the original testing is available at:

Distributed out of Louisiana:
http://www.physiomed.de/index.php?id=372
Distribution network national/international

National and international agencies and partners in over 83 countries guarantee competent and individual consulting as well as straightforward help. This distribution network has ensured for optimal after sales service since 1973. Do not hesitate to contact us. We are looking forward to getting you in touch with a partner of ours near to you!

PHYSIOMED products are distributed in the United States by:

PHYSIOMED North America, LLC
401 Lakeview Drive
Farmerville, LA 71241
USA

PHONE 318 368 7266
E-FAX 501 325 6683
E-MAIL [email protected]

PHYSIOMED North America, LLC is independently owned and operated and is not a part, branch, affiliate or agent of PHYSIOMED ELEKTROMEDIZIN AG.

Note: Anyone reading my posts on electromagnetic therapy please do your own research as to its efficacy and whether there can be any contra indications to one's health.
Posted 11/4/2015 3:41 AM (GMT 0)
Good work Martin. I was wondering where the Magna Vetri was available and the cost. The incredible thing is that these machines, as of now, are available to the public. The not so incredible thing is I think I'll have to go back to school to be able to understand which machine is appropriate and the science behind it.
Having the right machine with the right pulse rate is apparently really important as you'll see in the following quote. This is from the first study which was performed on humans before the dog study. In Urology 2011"Effects of pulsed electromagnetic fields on benign prostate hyperplasia" There was a footnote in this study which states that some levels can kill cancer and others promote it. Here's what it says:
. "Unpublished data of ours indicate that pulsed EMFs as those generated by the PAPIMI device may induce either enhancement or reduction in the proliferation rate on prostate cancer cells depending on the pulse rate (pps) of the field. Pulse rates above 6 pulses per second (pps) induced a significant increase, whereas less than 4 (pps) induced a significant decrease in the proliferation rate of prostate cancer cells (P \ 0.05). Similar effects have also been found on wound healing effects of radiofrequencies generated by the PAPIMI device [8]. According to this finding, the rate of 4 pulses per second (pps) to expose BPH patients was chosen."

The Papimi was the device they used in their study
Posted 11/4/2015 4:16 AM (GMT 0)
Michael: The study on dogs stated: "A frequency of 4-12Hz and intensity of 1000 Gauss was used." ...generated by the Magcell Vetri. It is interesting the data you state on the Papimi device.

On November 17th I am visiting my urologist for a rectal ultra sound, the first time I have done so in 33
months since I have had the Gat procedure. Should be interesting to see if my prostate shrunk. At the 6 month mark after the procedure there was no change...45-50 grams.
Posted 11/4/2015 3:25 PM (GMT 0)
Hey Martin,

I was very excited at the suggestion on Parsemus website about getting a machine and trying it. I'm going to see if I can get any pricing info.

The whole procedure is the kind of thing I'm really interested in. I actually had my sister in law sent me information on how to understand the p values they use in studies to rate effectiveness.

Did you look through the earlier human study?

Best of luck with your sonogram. Let us know the results.

My problem after the Urolift is I have a PVR of about 3-400 ml. I am cathing once or twice a day because I'm concerned about bladder/kidney issues. So I know I need to eventually do something that will address the residual/retention. I've been free of any urgency or frequency in the day but wake up once or twice a night. Just stopped Tamsulosin a couple of days ago to see if I still really need it.

All the Best!
Posted 11/4/2015 3:43 PM (GMT 0)
Hey Martin,

They carry a machine that is the same but only difference is the timer. Costs $695. (I was afraid it would be much more) The women there didn't know about the earlier human study. I have a pdf of the full study which I'm forwarding to her to research that issue of effects on cancer cells of different settings/strengths.

If you had the Gatt Goren do you need to do something further?

M
Posted 11/4/2015 4:18 PM (GMT 0)
Michael: Nothing further to do. I used to be in constant touch with Dr. Gat. I get up once or twice at night depending upon amount of liquids I drink. PSA has never gone over 0.6 or 0.7 ...ever. So based on this I don't see any inflammation...never had prostatitis but slow, sometimes at night very slow...urinary stream. Median lobe protrusion is a problem...It is bigger than both other lobes combined...but still based on rectal ultra sound of 3 years ago, total size is 45-50 grams....73 years of age.
Posted 11/8/2015 6:39 AM (GMT 0)
Hi Guys,
It's been several months since I posted. As previously mentioned I had a second incident of gross heamturia that required a turp and then a follow up surgery to stop bleeding and clean up clots during the month of April. It took me a good 4 months to feel normal again after the blood loss, general anesthesia and the two surgeries. I'm due for a 6 month follow up with my urologist and had an ultrasound (not the TRUS, just the standard US of the abdomen, bladder and prostate done last week). I was surprised that there was little change in the measurements of the prostate, even though my urologist told me he removed about 70g. during my 2012 laser greenlight, and another 70g. during my turp 6 months ago. At one point he had told me the prostatic capsule doesn't shrink, so maybe that's why the measurements haven't decreased significantly.

Here's my question to the group. Several of you who have had the Gat Goren have stated that your prostates decreased in size after the procedure. How was that decrease measured? Was it by TRUS, MRI, CT or some other method? Or was it just the doctor's observation with a cystoscope? I have scoured google but came up with no info on prostate measurement after any bph procedure. I figure if some of the posters here reported a decrease in prostate size, I would appreciate knowing how it was measured, before and after. Thank you.

P.S. Some of my googling did come up with cases of prostatic adenomas (benign turmors) that doubled the size of an already very large prostate in just two years. Since my US showed a dark circular area about 2cm across and 1-2 cm thick, I'm thinking maybe that is what I have too. I did have the tissue removed after my April turp sent to pathology, and they reported no malignancy.

Post Edited (Bob_NJ) : 11/7/2015 11:44:34 PM (GMT-7)

Posted 11/8/2015 4:55 PM (GMT 0)

Bob_NJ said...
Here's my question to the group. Several of you who have had the Gat Goren have stated that your prostates decreased in size after the procedure. How was that decrease measured? Was it by TRUS, MRI, CT or some other method? Or was it just the doctor's observation with a cystoscope? I have scoured google but came up with no info on prostate measurement after any bph procedure. I figure if some of the posters here reported a decrease in prostate size, I would appreciate knowing how it was measured, before and after. Thank you.

Here's how my prostate was measured:

Before procedure: 51 g, intra-abdominal ultrasound (painless) by diagnostic radiologist
1-year post procedure: 22.3 g, TRUS (painful) by skeptical urologist

Comparing my "before" and "after" measurements is something of an apples-to-oranges comparison because the intra-abdominal ultrasound typically gives a larger measurement than TRUS: about 15 percent larger according to an earlier post on this board, if my memory serves. The apples-to-apples comparison of my post-GG measurement would be 25.645 g (=1.15 x 22.3).

HTH.

Post Edited (Chicago Dave) : 11/8/2015 10:05:50 AM (GMT-7)

Posted 11/8/2015 6:17 PM (GMT 0)
Thanks Dave. Is the "intra-abdominal ultrasound" the standard US, lying on your back while they probe your bladder and upper pubic areas with the US device?
Bob

Chicago Dave said...

Bob_NJ said...
Here's my question to the group. Several of you who have had the Gat Goren have stated that your prostates decreased in size after the procedure. How was that decrease measured? Was it by TRUS, MRI, CT or some other method? Or was it just the doctor's observation with a cystoscope? I have scoured google but came up with no info on prostate measurement after any bph procedure. I figure if some of the posters here reported a decrease in prostate size, I would appreciate knowing how it was measured, before and after. Thank you.

Here's how my prostate was measured:

Before procedure: 51 g, intra-abdominal ultrasound (painless) by diagnostic radiologist
1-year post procedure: 22.3 g, TRUS (painful) by skeptical urologist

Comparing my "before" and "after" measurements is something of an apples-to-oranges comparison because the intra-abdominal ultrasound typically gives a larger measurement than TRUS: about 15 percent larger according to an earlier post on this board, if my memory serves. The apples-to-apples comparison of my post-GG measurement would be 25.645 g (=1.15 x 22.3).

HTH.

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