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Gat Goren, PAE, LUTS, Part 7

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Posted 11/8/2015 7:08 PM (GMT 0)

Bob_NJ said...
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

You described it accurately.

I had mine done in Costa Rica by a US board-certified diagnostic radiologist. He did it at the same time as the bilateral Doppler color ultrasound, which Dr. Gat needed. They used the same machine. Whether the machine was made in the US or not, I don't know: but I assume it was state of the art tech. I assume it's a standard procedure in the US. I recommend it--it's painless, and they can look for other abnormalities at the same time.
Posted 11/8/2015 9:13 PM (GMT 0)
1rphguy,
I was very worried about retro, which is why my doctor did two greenlight laser turps on me, sparing the area around the ejaculation duct each time. The first greenlight laser in June 2012, was to remove prostate tissue, the second in Dec. 2013, was to trim the bladder neck (called a bladder neck resection) and remove bladder stones.

However after my gross hematuria and clotting in April, 2015 he could not schedule a greenlight laser machine and so reverted to the classic turp technology. There was a lot of bleeding before and after the turp and I needed a second surgery two weeks later to clean up the clots and stem the bleeding. I almost needed a third surgery, two weeks after the second, after a total of 6 pints of whole blood transfusions before and after the surgeries, but fortunately the bleeding stopped on it's own the day before I was scheduled for the third surgery.

Regarding the turp, I can say it was a better recovery, less painful and shorter than either of the two greenlights or the TUMT I had a year before the first greenlight.

Since April, I have not taken any drugs of any kind (other than a month of antibiotics following the turp). I even stopped my blood pressure medicine because it contained a diuretic. I have no diet restrictions of any kind. I drink about a quart of coffee in the morning and a half bottle of chianti every night. I'm back to being able to eat red hot potato chips, hot Mexican and Chinese food with no problem. My flow is good. I haven't needed to cath. I go about 3 times a night, roughly 300 mls. per time, using a bedside disposable 1 liter urinal in the dark and am back to sleep in minutes.

My biggest worry was the retro. The funny thing is that it is completely unnoticeable to me. I still have all the sensations of a great pumping orgasm, only the liquid goes up into the bladder. There is exactly the same feel to me. I spent a lot of time worrying about the one thing that was a total non-issue for me.

Bob

1rphguy said...
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.

Post Edited (Bob_NJ) : 11/8/2015 2:20:10 PM (GMT-7)

Posted 11/9/2015 1:50 AM (GMT 0)
########## 4-1/2 YEAR UPDATE ############

How time flies! The calendar says it's almost been 4.5 since my Gat-Goren (GG) procedure of 30 May 2011. I'm filing my report three weeks early because I'm in the mood--and because it's timely following the discussion about my before-and-after GG prostate measurements.

No news here. Very stable. No changes in urinary function for last 1-1/2 years, really. Testosterone very low, but rock solid. No dives off the deep end like I was experiencing before GG. I have not taken a Rx pill for at least 1-1/2 years; I discontinued my routine Rx drug of choice (Rapaflo) 2 years post-GG. I haven't taken non-Rx or herbal meds for over six months (though I intend to start playing with those shortly, and maybe adding a small monthly dose of Hytrin, too, into the mix).

The improvements over the first three years had to be due exclusively to the procedure itself, but I hadn't changed my diet, my non-exercise regimen, or my supplements. I still experience some occasional frequency and discomfort while sitting, but it is a night-and-day difference than before the procedure when I couldn't make it through the day (or night) without my daily fix of Rapaflo. I find that taking vitamins makes things worse, especially water soluble vitamins like B and C. I don't drink alcohol, coffee or caffeine for almost 15 years, so I can't report whether these aggravate it too. At night I find that I might have to get up once toward morning, but it's difficult to separate which of my age-related conditions calls me to the bathroom.

So I like the procedure, what can I say? It really helped my urinary ("prostate") problems, and it treated the depression I experienced in 2010 and early 2011 due to bungee-jumping testosterone levels.

Now on to other serendipitous news. I have this friend on the West Coast, see, and.... Well, two years ago he told me he was having some type of mild libido problems. This is sort of like deja vu all over again, because he had to listen to my similar stories back around 1992. I told him to get his hormones measured, because it would serve him well in the future knowing the baseline values. Blah, blah, blah. So last week when we're talking, he lets on that his prostate was "moderately enlarged," according to his urologist. But still no symptoms of "prostate" problems though, which is good. To me, this sounds suspicious. I'm trying to put my friend in contact with Dr. Gat. I assume that Dr. G would ask for a bilateral Doppler color ultrasound to diagnose varicocele. And now I'm really curious what that result would be.

I promise to keep the board informed on any developments for me or my West Coast friend.

-dave
Posted 11/13/2015 4:13 PM (GMT 0)
So is there places in the US where I can get the Gat Goran method or a similar vascular approach to prostate reduction? And get it covered by Medicare?
Posted 11/13/2015 5:22 PM (GMT 0)
The PAE (Prostatic Artery Embolization) is becoming available in many places in the US. I am now considering it myself. Even though I presently have no symptoms after two greenlight procedures and a turp in just 3-1/2 years, my prostate continues to grow back at a crazy fast rate over the last 4 years. In Oct, 2011 my prostate was 110g., measured bu U/S. By January 2012, a catscan measured it at 206g. Just before my Greenlight laser in June 2012 an MRI measured it at 303g. I had a greenlight laser in June, 2012 and again in Dec 2013. By October 2014, an U/S showed it was back up to 313g. I had a standard turp in April of 2015 and an U/S last week had it measured at 203g.

Two promising outcomes of the PAE from posters I read on the patient.info forum are from two men with prostates over 200g. and 300g. respectively. They got about a 25% to 30% reduction in their prostates within 6 months of the PAE. Other studies on PAE that I have read indicated a follow up period of two years without regrowth or rise in PSA. There are about 500 posts on the previously mentioned forum on PAE. To locate the discussion, google the following phrase:

Patient.info Has anyone out there had a Prostate Artery embolization

I don't know for a fact but can't see why medicare wouldn't cover it, but you can find out by calling any doctor or hospital or medical group that performs the procedure.

There's several hospitals on the east and west coast who have been doing the procedure for several years now, but now that it is becoming a mainstream bph treatment, many others are starting to offer it.

Hackensack University Medical Center, in my state of NJ now performs the PAE. I'll see my uro next week and talk it over with him. With the way my prostate regrows, it seems a PAE or a simple prostatectomy are my only choices, other than getting a turp every other year, which is not something that appeals to me. My blood HGB, iron and folate counts are still below normal after my surgery in April. After the turp the removed tissue was sent to pathology and no cancer was found. However my PSA has steadily risen over the last 4 years from 5.5 to 7.8.
Bob


t walgamuth said...
So is there places in the US where I can get the Gat Goran method or a similar vascular approach to prostate reduction? And get it covered by Medicare?

Posted 11/13/2015 7:13 PM (GMT 0)
Dave...Yes. How time flies.

Today I visited my urologist after 39 months of having the Gat Goren Procedure. The doctor is a highly esteemed John Hopkins graduate who has been in practice for 30 years. The verdict from the Doctor. The Gat Goren Procedure works. The urologist (to his credit) admitted that I know more about the prostate than anyone on his staff. (Which I do, excuse the conceit)

Although my prostate has always been considered small, I had this problem of a median lobe protruding into the bladder. Prior to the procedure, the size of the prostate was 45-50 grams with almost 2/3 of that size being median lobe.

Today, the good news was that the size is still the same, but has not increased. The bladder has not thickened. My PSA of 0.7 has never gone higher than this number. Post residual void was about the same...100.

But....In other words, the ISV embolization will not shrink a large median lobe but it will prevent it from getting larger. The doctor found that those doing PAE have no shrinkage of the median lobe. He also felt that no one yet knows the long term effects of PAE on the prostate which involves necrosis of part of the organ.

Also, a 15 minute bladder neck type type incision is 80% effective in preventing retrograde ejaculation for those who have a median lobe problem. But, those odds are not good enough for me. I will live with getting up once or twice a night to urinate, even though the doctor said it would positively change my life. C'est la vie!

For those who can afford an expensive procedure, I would highly recommend speaking to Dr. Gat.
Posted 11/14/2015 1:46 AM (GMT 0)
Bob... Has anyone given you an answer as to why your prostate continues to grow to such a large size. We do know that DHT increases the size of one's prostate causing hyperplasia and hypertrophy. Are your hormone levels in balance? You haven't gotten to the cause of your problem. Treating the symptom by doing Turps, PAE or at worse a prostatectomy is not the answer in my opinion.
Posted 11/14/2015 8:30 PM (GMT 0)
Hi Martin,
Thanks for your reply. Not only has no one explained it but I am a little bummed I didn't react to it either. My sonogram a year ago in Oct.2014 showed a prostate of 313g., but I was so pleased that my pvr was less than 25ml., and I had a great stream and was voiding large amounts (300-400cc at a time) that for some inexplicable reason, I never discussed the prostate size with my uro, and he didn't bring it up either. (By the way, to your ealier point, in Dec. 2013 I did get a bladder neck resection and removal of bladder stones after my first hematuria, and I did not get retro, and my stream and volume increased by about double and my pvr decreased from about 200 to less than 25ml.)

The following April, 2015 the hematuria came back and he did the turp so I was preoccupied with recovering from that for the last 6 months. My blood HGB and iron and folate counts are still below normal. I'm taking B12 and extra folic acid and iron to get that up over the next 3 months. I could also get an iron infusion if that doesn't work.

I suggested to my uro in August, 2015 that I get an U/S 3 or 4 times a year to monitor the growth after the turp and he was anticipating about a 65-80 g. prostate. I will see him Tuesday. Actually I'm not sure how the second U/S showed a 110g. reduction from 313g. last October to 203g. a few weeks ago. After the turp in April he said he took out about 70g. The new U/S showed a hypoechoic (dark) round area about 2cm cubed in the center of the prostate so maybe that is a necrotizing area that's reducing the prostate more than he removed? Or maybe he removed more than he thought he did.

Obviously I don't want to be getting a turp every year or two for the rest of my life. I imagine a simple prostatectomy would solve the problem for once and for all, wouldn't it? Maybe a PAE would stop the growth as well?

My testosterone actually came up from 207 to 287 this year. At this point I wish there were other alternatives to take 150g. off my prostate and stop any regrowth, but other than the prostatectomy I am not aware of anything else that could do that. If the PAE could take 65-110g. off my prostate and stop all future growth I guess that could be a viable alternative. But I'm really in the dark here. I don't know if PAE will stop all future growth, or even if a simple prostatectomy would (though it sounds like it ought to).

P.S. Some additional googling brought me to clinical trial results of a drug called dutasteride that inhibits DHT and resulted in a 25% reduction in prostate volume over 2 years, that increased to a 27% reduction in volume over baseline at the 4 year mark.

Bob

martin victor said...
Bob... Has anyone given you an answer as to why your prostate continues to grow to such a large size. We do know that DHT increases the size of one's prostate causing hyperplasia and hypertrophy. Are your hormone levels in balance? You haven't gotten to the cause of your problem. Treating the symptom by doing Turps, PAE or at worse a prostatectomy is not the answer in my opinion.

Post Edited (Bob_NJ) : 11/14/2015 2:28:44 PM (GMT-7)

Posted 11/18/2015 6:45 PM (GMT 0)
Just an update on my previous posts last week. I spoke with my uro last night to discuss the rapid growth of my prostate. After my turp in April a recent sonogram showed it as 203g. A year ago, prior to the turp it was 313g. My PSA also went up to 7.8 from 6.0 last year. My LUTS symptoms are all good, strong stream, complete emptying, minimal PVR less than 40ml. I'm presently down to 2 or 3 urinations a night, which are probably due to reduced bladder capacity caused by years of bladder wall thickening due to bph. When I had urodynamics testing several years ago I was told my bladder capacity was about 350g. before I felt an urgent desire to void. My voids at night are just about at the 250 to 350 ml level each.

I brought up the PAE procedure offered at Hackensack (NJ) University Medical Center. Hackensack Hospital has been voted the best hospital in NJ, so he couldn't dismiss them out of hand. He said he would look into it and if I decided to go that route, would offer to assist if allowed.

Further discussions on the option of the retropubic simple prostatectomy brought up the fact that the prostagte could still regrow after that procedure as some of the adenoma would be left behind. I imagine that would also be the case with the holep procedure. For most people the prostate grows back slowly, maybe 5% a year. But for people with huge prostates that reach over 200g. or 300g. the rate is much faster, anywhere from 20% to 50% per year. The only procedure he could offer personally was the retropubic simple prostatectomy or repeated periodic turps, neither of which seemed like a good long term strategy to me.

In my last post, after Martin Victor mentioned the DHT connection in prostate growth I came upon the drug dutasteride, known as Avodart. The results of Avodart in trials seemed very similar to those of the PAE procedure, mainly an 85% or more reduction in serum DHT, and a 25% reduction of prostate volume over 2 years, with the results persisting over an additional 2 years of being tracked in the study. There was also the added benefit of a 20% increase in serum testosterone.

The avodart may have side effects and some people will find them worse than others. The main reported side effects were ED, loss of libido, and growth of man boobs. The extent and effect of the side effects vary from person to person. In 2 year clinical trials the positive results were as stated above. Only 5% of the participants chose to leave the study due to the side effects. Those who used Avodart in conjuction with tamsulosin (which I no longer need) had a larger incidence of side effects and of leaving the study (8%).

Bottom line, I am starting on the Avodart tomorrow and will get another sonogram and PSA test in 6 months to guage the progress. The Avodart and a similar but less powerful drug finasteride (Proscar) ssem to be the only long term drug solutions to reducing prostate size. The PAE seems to be the only long lasting prostate reduction procedure available in the US. When I asked my uro if a prostate my size or larger posed a health risk, he said it did not, as long as it didn't impair my urine flow or cause retention. Most blurbs about prostate size on the internet echo this sentiment, that many men have very large prostates and no symptoms. However the premise does seem counter intuitive if you are dealing with prostates that can be several hundred grams.

Bob
Posted 11/18/2015 9:29 PM (GMT 0)
Bob: I think you are making the right decision with Avodart. I have explored numerous herbs which claim to reduce DHT but all of them have little effect and also unfortunately reduce testosterone. Progesterone is perhaps the largest inhibitor of DHT production but again it will also reduce testosterone even though there is some conflicting information on this. Best of luck!
Posted 11/19/2015 3:26 AM (GMT 0)
Thanks Martin. I hope it works. It never hit home before but it seems for most people there's a wider range of options. For people like myself that have very large and fast growing prostates the choices are fairly limited.
Bob

martin victor said...
Bob: I think you are making the right decision with Avodart. I have explored numerous herbs which claim to reduce DHT but all of them have little effect and also unfortunately reduce testosterone. Progesterone is perhaps the largest inhibitor of DHT production but again it will also reduce testosterone even though there is some conflicting information on this. Best of luck!

Posted 11/19/2015 1:49 PM (GMT 0)
Bob: The optimum level of DHT is in the range of 30-50 ng/dL. Estradiol also plays a part in the enlargement of the prostate. Optimum levels should be in the range of 20-30 pg/mL. Life Extension Foundation discusses hormone balancing as an essential part of good health.

http://www.lifeextension.com/Protocols/Male-Reproductive/Male-Hormone-Restoration/Page-01
Posted 11/23/2015 8:19 PM (GMT 0)
Hi Martin,
Thanks for the additional info. I've been on the 0.5mg dutasteride (generic Avodart) for a week now and haven't had any adverse side effects as of yet. The plan is to get another ultrasound to measure the prostate and the PVR in 6 months. I guess that will dictate the likely future course of action or inaction. As I've posted before I've had two serious hematurias of the prostate in the last 2 years (requiring a total of 14 pints of blood transfusions). An added benefit of the dutasteride is it inhibits bleeding of the prostate. My hemoglobin and folate is still below normal and my GP advised me to take ferrous sulfate, folic acid and B12, which I've been doing for a couple of weeks with no ill effects either. I'll get my blood checked in 3 months. If the dutasteride doesn't shrink the prostate my only other alternative at present is to try the PAE, which is now offered in NJ. After 3 surgeries in 3 years, I sure don't want another one.
I'll keep my fingers crossed.
Bob

martin victor said...
Bob: The optimum level of DHT is in the range of 30-50 ng/dL. Estradiol also plays a part in the enlargement of the prostate. Optimum levels should be in the range of 20-30 pg/mL. Life Extension Foundation discusses hormone balancing as an essential part of good health.

http://www.lifeextension.com/Protocols/Male-Reproductive/Male-Hormone-Restoration/Page-01

Posted 12/9/2015 7:08 PM (GMT 0)
Bob: You might wish to contact the Sperling Prostate Center for their unique treatment for BPH. They do focal laser ablation using a 3 Tesla MRI, the most advanced technology today. No retrograde ejaculation. They do not do a TURP through the penis. Here is what they say... (Please excuse the long write up from their website...but it provides the information many might appreciate.)

The Sperling Prostate Center offers a unique new FDA-approved approach to treating BPH. With the same kind of MRI-guided focal laser ablation (FLA) used to treat individual prostate cancer tumors, Dr. Dan Sperling has developed a patient-friendly outpatient treatment that eliminates BPH in a single treatment with minimal-to-no side effects.

Description

Focal laser ablation for BPH (FLA-BPH) permanently relieves BPH-related urinary symptoms by reducing the enlarged TZ tissue causing urinary blockage. This process is called debulking because it diminishes the bulky BPH tissue. The ablation is done with the type of laser that coagulates, not vaporizes, tissue. By ablating targeted areas of the transitional zone near but not touching the urethra, FLA-BPH creates strategic tissue shrinkage by generating harmless scar tissue that will be reabsorbed by the body. There is no post-treatment urinary blockage, because no dead tissue will pass through the urethra; however, some patients may experience minimal blood in the urine as the prostate heals. There are no residual urinary or sexual side effects because the treated areas are contained will within the prostate gland away from other healthy tissues and structures. The urinary symptoms of BPH begin to diminish within a few weeks as the resulting scar tissue is reabsorbed by the body.

The procedure

FLA-BPH is performed under real-time 3T multiparametric MRI guidance. Unlike all other treatments for BPH, which are transurethral (access the urethra through the penis), FLA-BPH is done using rectal access so there is no risk of urinary irritation or infection.

A local anesthetic to numb the entire prostate area is administered and the patient lies prone on a table that slides into the MRI tunnel (also called the bore). The area to be treated is calculated based on the detailed MRI scans that clearly show where the BPH is constricting the urethra. A hollow needle guide is inserted into the prostate through the rectum. This allows a very small laser fiber optic to be placed precisely at the center of each area to be treated.

When the fiber is correctly placed, the laser is activated for a brief time, usually 2-3 minutes. During the ablation, a special type of software shows temperature changes in the tissue being treated, and confirms that there is no heat damage to surrounding tissues. Following ablation, the MRI is used to confirm each area that was ablated.

When sufficient tissue has been destroyed, the laser fiber and needle guide are removed. Any further treatment confirmation occurs with another MRI scan, if needed. The patient gets dressed, and the treatment is done.

Side effects

There are no side effects from FLA-BPH because the urethral lining has been preserved, and no dead tissue can escape into the urethra. Furthermore, baseline erectile function is preserved because the TZ is within the prostate and not adjacent to the neurovascular bundles that control erection. Finally, the side effect called retrograde ejaculation (semen flowing backward into the bladder) that can occur after TURP or Green Light laser does not happen after FLA-BPH, because the structural anatomy of the prostate, urethra, and seminal vesicles is not affected.
Posted 12/9/2015 10:09 PM (GMT 0)
Hi Martin,
This may be a promising treatment but as yet is too new to report long term benefits or problems. I read a paper about using the technique for killing PC cells and tumors, but the areas covered were less than 2cm cubed and took 8 to 10 minutes of ablation. My prostate is currently 20 cm cubed, and prior to my turp in April was 30cm cubed. I presently have no blockage so they would have to use this procedure to ablate the whole prostate and I don't know if it is set up for that. I also don't know if it would prevent future growth which is the crux of my problem. The first procedure I had was the TUMT (Trans Urethral Microwave Therapy) which ablated prostate tissue with microwaves, and that only lasted a few months. The TUMT has basically been declared a complete failure in the literature.

There is so little literature on the treatment of fast re-growing prostates above 200g. that I doubt if doctors have even devised a strategy for it. PAE sounds promising and Dutasteride sounds promising if either or both can permanently stop fuure growth. I'll know if the dutasteride has worked in about another 5 months when I get another sonogram. All my sonograms over the past 4 years indicate about a 50% to 60% growth rate per year. At present the only known sure solution would be removal of the entire prostate gland and capsule with a radical prostatectomy. That can have some very severe side effects, and most doctors wouldn't do it for bph in the absence of PCA.

I already have retro ejaculation after my turp in April, and have considered it the least problematic side effect I have encountered with the treatments and medications I have taken for BPH in the past 5 years or so. The first time I experienced retro I didn't notice any difference, and didn't know it had happened.
Bob
Posted 12/18/2015 6:49 AM (GMT 0)
Martin Victor Hi. You say that this Sperling approach has FDA approval. I couldn't find it on their site. But, if it has, that is certainly a standard not to be sneered at. Although, there is no attempt to provide the visitor to the site with any statistics as to the success or failure of the procedure. It does say: Low Risk of Incontinence, Low Risk of Impotence, which is actually a bit ominous.

I would, of course, change my skeptical approach to the GG method if it had FDA approval and still had no statistics pertaining to success or failure rates. The GG method seems so much less invasive than having an optical fiber inserted into the prostate by way of my rectum.
Posted 12/18/2015 4:08 PM (GMT 0)
Clap,
It seems unlikely the FDA would ever consider approving the Gat Goren, which is a unique procedure being done overseas. What is more likely is that they will approve the PAE done in the US for bph. That procedure is approved in the US for hematuria but not for bph. But many US facilities are performing the PAE both in FDA trials, and for bph patients.

I think the only difference is that Medicare and some insurance plans won't cover it for bph. But if you get it for hematuria they might. On another forum discussing PAE, patients in the US, Australia and the UK are getting PAE and in many cases it is covered by insurance, or by their national health services. In other cases people are paying about $6,000 plus travel expenses to get the procedure.

Based on about 4 years of trials and also from anecdotal posts by people on the other forum, the PAE (like the Gat Goren) works for some people and doesn't work for others. But no one for who it didn't work has posted any negative side effects other than some initial bruising and healing pains.

You can find the other forum thread by googling this phrase:

Has anyone out there had a "Prostate Artery Embolization??

The forum is patient dot info but googling the above line will bring you to the thread which has about 500 posts.

For those for whom it works, trials have reported a 25% to 33% reduction in prostate volume over a six month period, which has resulted in a large improvement in symptoms. The gains have persisted in the trials over the following 18 months. I think 2 years is as much as has been reported on.

To me it seems the results are similar to the posted results on people taking avodart ... a 25% reduction in prostate volume in six months, which persists as long as the person taking the drug. So for me the issue is
whether I want to continue taking the drug for life, or at some point have the PAE and stop taking the drug.

Not every one can have a PAE. They have to map the artery path to the prostate with an MRI with dye to see if it can be done. I think most people can get it done, though they say people with "torturous arteries" can not.

Clap, what are you doing for your prostate bph issues?

Bob


ClapTheHammer said...
Martin Victor Hi. You say that this Sperling approach has FDA approval. I couldn't find it on their site. But, if it has, that is certainly a standard not to be sneered at. Although, there is no attempt to provide the visitor to the site with any statistics as to the success or failure of the procedure. It does say: Low Risk of Incontinence, Low Risk of Impotence, which is actually a bit ominous.

I would, of course, change my skeptical approach to the GG method if it had FDA approval and still had no statistics pertaining to success or failure rates. The GG method seems so much less invasive than having an optical fiber inserted into the prostate by way of my rectum.

Post Edited (Bob_NJ) : 12/18/2015 9:25:53 AM (GMT-7)

Posted 12/21/2015 4:08 AM (GMT 0)
Hi Bob. Thanks for the interest. My symptoms are simply not bad enough to 'get something done'. My prostate is 'slightly enlarged'. I often get a full nights sleep depending more often on how I keep myself warm. And how much liquid I consume before I go to sleep. I drink at least 2 1/2 liters of liquid during the day rising to perhaps 4 1/2 during the summer. Usually pretty diluted tea with various green herbs in it depending on the season. I don't drink alcohol. It's not a principal. Just a habit. An occasional glass of wine. Some coffee. Not much. My diet included as much fruit and vegetables as possible. No red meat. Red meat in Israel is .... kosher and not that tasty. I wish that I didn't eat any meat but, I like chicken.

PSA way below 1.

about 6 years ago, a urologist attempted to prematurely persuade me to undergo some laser treatment. He said that it would effect my ejaculation. On consultation with my family doctor, I 'forgot' about it. In the meantime, I have learned a lot. And give thanks to the Great Sky Pixie that I didn't follow the urologist's advice.

Post Edited (ClapTheHammer) : 12/20/2015 10:46:32 PM (GMT-7)

Posted 12/25/2015 1:51 PM (GMT 0)
>>> Based on about 4 years of trials and also from anecdotal posts by people on the other forum, the PAE (like the Gat Goren) works for some people and doesn't work for others.<<<

Well after almost 3 1/2 years, it appears my median lobe is shrinking.

02/13/13 Urology Transrectal Report...Prostate was 54 g with the median lobe and 22 g without the median lobe.

11/13/15 Urology Transrectal Report...Prostate was 50 g with the median lobe and 26 g without the median lobe.
Posted 12/31/2015 9:13 PM (GMT 0)
My psa jumped from 8 or 9 to about 15 so I went to the urologist who performed thew Urolift on me. I was pleased to find that there have been some improvements in urology. He recommended we draw blood for the 4kscore which is a blood test that gives you a percentage that rates your chances of having an aggressive cancer. If that is inconclusive or looks bad then he recommended the 3T MRI with contrast which gives really good high resolution imaging of the prostate. All that before a possible biopsy. Plus the MRI shows areas that deserve to be biopsied. As for the blood tests to stage or determine PCA there are a slew just about to be released:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110681/
My only hesitation with the MRI is the side effects of the contrast dye. Put in Mercola and contrast dye in google
Posted 1/10/2016 2:04 AM (GMT 0)

Chicago Dave said...
This thread focuses on whatever guys want to post about. When it started it was rather limited to GG, but later on guys started posting about their experiences with PAE and other methods. So the thread expanded to accommodate the new interest and new information.... The more the merrier, I say.


A poster on HW PCa forum pointed me to this thread after I started one on BPH.

I am learning a lot.

I am taking 5mg cialis daily, and get up about four times a night. Usually make it about two hours sitting on a road trip or airplane and have to find a toilet or start getting plugged up.

Have been putting off TURP and anything invasive until there is something with little or no side effects.

Also, one of my physicians practices Integrative Medicine (he is a board certified Internal Med Dr, practicing in NC) and mentioned to me that prior to surgery being done that historically prostate massage was done for weak urine stream and to increase flow.

When I get seriously choked up, before going to an exigent care center to be catheterized I will have my wife put on a glove and give me a prostate massage. This is so effective that I now pack several gloves when traveling. Excessive sitting as can happen when traveling will likely cause a problem.

I am aware that I will likely have to do something in the future although I seem stable at the moment.

Hopefully, I will be able to make it several more years as more information and new procedures become available
Posted 1/25/2016 6:38 PM (GMT 0)
Just a quick update. I'm on the 0.5mg daily dutasteride (generic Avodart) for a little over two months. So far no noticeable side effects (no man boobs or loss of sex drive). Urine stream seems better. Two weeks ago I expelled a piece of bloody tissue about the size of an aspirin, which I thought may have been a "hanging chad" left over from from my turp in April. Urine had been burning at the end of the stream about two weeks before expelling the tissue, but was fine afterward.
Will go for a sonogram in May to measure my prostate size and PVR. Waking at night down to 2-3 times. Sleep 6-7 hours a night. Last night got up only once to use my bedside urinal and voided 600ml. That's twice as much as I can normally hold. Wonder if the dutasteride is somehow improving my bladder as well.
Don't know if there's a connection but my BP readings rose about 10% about a month ago. I went back on my bp meds Micardis HCT, three weeks ago, which I hadn't taken in about a year.
Bob
69 years old.
PSA 11/3/15 = 7.8
Sonogram PVR Oct 29, 2015 = 32ml.
Sonogram Prostate size Oct 29, 2015 = 9.1x4.2x10.2cm x 0.52 = 203 g.
GL laser to reduce prostate and median lobe, June 2012,
GL Laser and Bladder Neck Resection, Removal of bladder stones, cauterize hematuria, Dec. 2013,
Turp to reduce prostate and median lobe and cauterize hematuria, April 2015.
Posted 2/16/2016 6:54 PM (GMT 0)
I had a lot of reading to catch up on the forum, I have been busy attending to other health issues one of which was a venaseal procedure prompted by my success with the Gat Goren procedure, mind you my success does not measure up to that of golfosca which is spectacular indeed. I am heading into my 14th month, very happy but I do not seem to have progressed much since my last report. Nevertheless the procedure was life changing and I am eternally grateful to the 2 docs and this forum where I found the information.
I am just beginning to cut out my medication on an occasional basis with no noticeable effects. I have had absolutely no infections which were a really serious problem pre Gat Goren.

I have not got around to visiting my urologist to measure my prostate and I might do that soon, it really is not important to me as I have fantastic relief. On reading through all the terrible suffering that some contributors have endured, I feel extremely fortunate
Posted 3/4/2016 6:27 AM (GMT 0)
Hi everyone. I've been busy. No change for myself. Bearable. Sometimes easy. Sometimes not.

BUT. I did notice this which describes tests for a new approach to treating prostate cancer.

http://mfa.gov.il/mfa/innovativeisrael/sciencetech/pages/new-drug-for-treating-prostate-cancer-approved-in-mexico-4-january-2016.aspx

And is undergoing actual medical trials.

But. The new 'thing' seems to be activating the body's own immune system against cancer by engineering 'immune cells' and, after cultured multiplication, re-introducing them into the body where they will destroy, 'almost naturally', aggressive cancer cells. Already used for some skin and blood cancers in the UK and ragingly successful. However, as of yet, very, very expensive.

Still. New things coming up all the time.
Posted 3/4/2016 11:22 PM (GMT 0)
I'm approaching four years post Gat Goren. I intend for the first time since the procedure to go for a full range of blood tests and send it on to Dr G. Current position: No drugs, night time visits normal unless I'm drinking late, so mostly no need to get up at night, Frequency normal, flow continuous but not like a hose under pressure, I always void twice. Verdict, very very glad and still very very happy I had the procedure.
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