Gat Goren Method

Hello everyone...

I have been following the Gat Goren method for BPH for 18 mos. now...read about it on Wikipedia, and have read the journal articles, and discussed it with my urologist...who doesn't seem to be very curious about it...I think he has his hands full with his standard practice...I really appreciate Andy's detailed reports.

Since I don't like the side effects of finasteride or flomax, and since I have to be careful to void fully regularly,
(I had the beginning of Hydronephrosis...the kidneys filling up with urine) I am doing a clean catherterization 4 or 5 times a day . It's a simple 2 minute procedure, non medical, non surgical....involves inserting a catheter in the penis . It sounds painful but it isn't. I mention this in case someone else wants to ask their Urologist about it. This not the same as having a catheter fitted ...it's the insertion of a catheter 4 to 6 times a day...also called in and out clean catherization...for me it's a great solution (interim...?) ..it just means having a clean catheter available when I urinate.

coming back to the prostate arteries embolization, I asked Dr Gat about this via email earlier this year, and encouraged him to attend an embolization symposium where prostate artery embolization was being presented in the US. His response:

"Unfortunately we are now late for presenting our knowledge. It is possible that we will attend the meeting.
In any case this meeting nay give a push towards positive direction namely, "from knife to catheterization" even though their attitude is completely non-optimal and again targeted to the symptom by strangling the enlarged prostate without a knife."

he had informed me previously that:

"It is not the same logic and hence completely different mechanism of treatment. It treats the symptoms and we hope they succeed. ."

It is encouraging that it is a non surgical (embolization) approach

I am looking forward to more updates from Andy and Yoav...

Post Edited (Michael_Ca) : 10/14/2012 8:48:17 AM (GMT-6)

It's been 4 years since the doctors' research. I have exchanged 3 emails with Dr. Gat. Each time I asked him point blank if he has any follow up on the patients he had seen; not necessarily formal studies, just any informal information.
Each time his answer completely avoided my question and gave an incidental answer.
A short term study does not necessarily predict long term outcome. It seems to me that Dr. Gat is trying to hide something.

First, Dr Gat did not provide any answer such as "not enough time for a study." Second, I asked for informal information Third if six months was time enough to get results then I would think 4 years would be enough, too.

Hi Jack. Hi Bob. I was posting here a few months ago to find exactly the same information that you two are looking for. My Urologist in Israel was very animated when I mentioned Gat/Goren. In a negative way.
However, Andy seems to be getting on well and since I have to be impressed by his results, it seems that Gat/Goren may have something.

BUT, the question still has to be asked - why hasn't he responded to requests for some statistical data on the long term performance of, say, even 20 patients. As I have written before, if his treatment is successful as he claims, surely he would be a candidate for a Novel Prize bearing in mind that quite a few of those deciding who will get the prize, would probably benefit from his treatment.

If it really works.

Well, I finally did locate a single report of 2 year follow up for the Gat Goren method, on google.

Here is a link to a March 22, 2011 news article in the Renal & Urology News:

http://www.renalandurologynews.com/novel-cause-of-bph-pca-proposed/article/198765/

The most important points of the article were:

"At the 26th Annual Congress of the European Association of Urology, Dr. Gat reported on a study of 63 BPH patients with prostatic symptoms and bilateral varicocele who underwent super-selective venography and sclerotherapy of the network of impaired testicular venous system, thereby eliminating the flow of free testosterone from the testes to the prostate."

"The mean follow-up was about two years. The treatment resulted in a significant reduction of some 50% of the pathologic volume (the enlargement beyond the normal prostate volume) over six to nine months and a parallel decrease in prostate symptoms, although 5% of men experienced recurrent varicocele."

I would summarize Gat's presented follow up as: After two years they can report that within 6 to 9 months, the procedure reduced the total volume of the prostate minus 25 grams (a normal prostate), by 50% with a 50% reduction in symptoms, in 60 out of 63 patients. All 63 patients had a bilateral (on one testicle) varicocele.

Whether his findings were only delivered verbally or were submitted in published form and vetted by his peers, I have no idea. But if true, and if permanent with no long term side effects, they are as good or better than other methods.

In the US, there are pretty vigorous critiques of experimental and new procedures. And there are lots of patient reviews of doctors. Although not definitive, they are a sort of public forum that gives some information. If Dr. Gat has his detractors in Israel, it's odd that google doesn't seem to display them. There doesn't seem to be patient reviews of doctors there like there are here.

Bob

Post Edited (Bob_NJ) : 10/15/2012 5:39:44 PM (GMT-6)

hi everyone, including the new members.... sorry I could not respond sooner.

Going back through the last few comments. I would say that I have been in communication with Dr Gat and I understand he is about to publish findings and data on 150 patients. That will certainly be interesting.

Dj pro, your comments make sense. One would expect the local urologist to be in the know about whats going on with G/g. So, it's surprising and slightly alarming to learn of the his comments. Still, despite those comments, I'm still alive and kicking thank goodness. So, what are we to make of the fact the G/G are both eminent doctors? Are we to believe that they have it totally wrong? If they are charlatans, it doesn't make sense - although it's not impossible.(Ref: Dr Harold Shipman- where thousands had confidence in him!). Again, speaking from my experience, I have seen an improvement and no longer take finasteride or diffundox. I don't take flomax daily but I'd mention that I have noticed that If I take flomax, the next day I see a slightly stronger continuous flow. So, I keep the flomax's ready when flow slows down. Overall, still happy with what I'm experiencing.

Bob, I believe that Drs G have identified varicocele in all their patients with BPH... Does anyone on the forum with BPH know for sure that they don't have varicoceles?

Hi! I am new to this board. On August 5th, the Gat Goren procedure was performed on me for a BPH problem. Except for a blood chemistry test done 6 weeks later which showed an increase of free testosterone of 16%, I have done no further testing. I have noticed less nighttime visits to the bathroom. The volume of my prostate was 45 grams prior to the procedure and a PSA of 0.6. Since the internal spermatic veins were occluded, I was concerned about alternative pathways for the free T to enter the blood stream. There are 3 alternative pathways. I believe I can provide extensive information on the procedure for anyone who is interested given my studies of biochemistry and nutrition.

Hi Martin, welcome aboard. I am also new to this blog. Thanks for your comments. I wish, hope and pray that you are right. Believe me, I am inclined to go through the procedure as do many others. I am also very careful when it comes to getting advise from a friend. As long as I can wait, assisted by the pills, I will not do any other invasive surgery until I am fully informed about the Gat Goren system. I appreciate your concern about the blunt interest of other Urologists. For now, I am guided by whom I know well. As I said, I wish we will be convinced otherwise.

djpro: I asked Dr. Gat who from the United States were his patients. Interestingly, they were primarily scientists from California..many of whom were from top rated Universities like Stanford. Now one would think that urologists are not immune from having BPH. So, I inquired if any urologists came to have the procedure done. From what I could ascertain, the answer was none. I gathered they are not open to a new procedure and are stuck in their ways. When you think about it, a fertility expert like Dr. Gat, would have a much better understanding of the anatomy of the reproductive system than a urologist. Dr. Gat and his team discovered a new pathway for the release of testosterone into the blood stream from the study of old anatomical records. Pathways include the scrotal vein, deferential vein and cremasteric vein. My prime interest was increasing my free testosterone and I was concerned that if the internal spermatics were occluded, that free testosterone and waste products from the testes would not have enough of a pathway to the bloodstream.

Bob: Varicocele embolization is common but entails complex surgery with multiple complications such as infection. Perhaps you would get a similar result but a surgeon would have to also deal with other veins that grow and compensate for the failure of the ISM's. These are also occluded during The Gat Goren technique which involves a non surgical interventional radiology method using local anesthesia and a catheter. It is a highly specialized technique using venous access in the groin to occlude the varicosity in the internal spermatic veins. Also, BPH is not only a combination of a mechanical failure of the internal spermatic valves common in most aging men, but also partly a result of high levels of DHT hormone causing hypertrophy (enlargement of cells). Primates and mammals who walk on all fours, have horizontal spermatics intstead of vertical spermatics. They never develop BPH. When the valves of the ISM's fail mechanically due to age, the gradient pressure changes and pushes free T from the testes on to the prostate causing cell change (hyperplasia). This is a result of humans walking erect. Free T flows a normal pattern in a reclining position (sleep) into the blood stream, but during an upright position (day), flows into the prostate 130x normal causing inflammation and possibly cancer??

Martin,

Thanks for the explanation.

I know I'm beating a dead horse but it is amazing to me that varicocele embolism and prostate surgery are acceptable here for other reasons, but combining them for bph in the gat goren method is not. Injecting botox in the bladder for interstitial cystitis is acceptable here, but injecting it into the prostate for bph is not, even though ten years of trials have shown it to be as beneficial as drugs.

Just wondering, don't chimpanzees spend a lot of time vertical? At least they appear to at the zoo and in nature films. They seem to spend a good part of their day sitting vertically (as I do at the computer), and some time walking semi-vertically. I wonder if chimpanzees get bph?

Bob

martin victor said...
Bob: Varicocele embolization is common but entails complex surgery with multiple complications such as infection. Perhaps you would get a similar result but a surgeon would have to also deal with other veins that grow and compensate for the failure of the ISM's. These are also occluded during The Gat Goren technique which involves a non surgical interventional radiology method using local anesthesia and a catheter. It is a highly specialized technique using venous access in the groin to occlude the varicosity in the internal spermatic veins. Also, BPH is not only a combination of a mechanical failure of the internal spermatic valves common in most aging men, but also partly a result of high levels of DHT hormone causing hypertrophy (enlargement of cells). Primates and mammals who walk on all fours, have horizontal spermatics intstead of vertical spermatics. They never develop BPH. When the valves of the ISM's fail mechanically due to age, the gradient pressure changes and pushes free T from the testes on to the prostate causing cell change (hyperplasia). This is a result of humans walking erect. Free T flows a normal pattern in a reclining position (sleep) into the blood stream, but during an upright position (day), flows into the prostate 130x normal causing inflammation and possibly cancer??

Clap... Recently a member of our forum did an ultra sound and found that his prostate size went from 73 grams to 43 grams within 4 months of doing the Gat Goren procedure. This is a dramatic decrease in such a short time and I have never seen specifics of any drug performing such wonders. Why do you have such doubt as to the efficacy of the procedure. I am currently a private investor with a group that is trying to raise money for clinical research for a phase 1 FDA approval of an anti-oxidant that acts like a drug. We have some of the finest scientists and doctors on board and still find it difficult to raise the kind of money needed for a clinical test. Gat-Goren are not Pfizer or Johnson & Johnson. You cannot say, oh...I have a great idea and believe money will fall down from the sky. Can you tell me the difference between the Gat Goren procedure that is 85% effective for fertility patients and the procedure that is 85% effective for BPH patients aside from the fact that one is widely accepted and the other isn't. Thanks!

With regards to the radiation from the procedure:

"the procedure took about 2 hours, but the fluoroscopy time was about 15-20 minutes. This is about the same as undergoing an air contrast barium enema. We use a digital fluoroscopic unit made by Philips and the rated dose is 2-4 cGy (centi-Gray, with 1 cGy = 1 rad, in the old nomenclature). It is less than a CT scan of the abdomen."