Gat Goren Method part 2

- the prostate will "stew" in used blood. -

As we are all trying to find and discuss effective alternatives to barbaric invasive resections and other potentially destructive surgeries, can you please qualify what appears to be a negative, unscientific and inflammatory statement about what is proving to be be a highly effective and minimally invasive alternative along with the GG procedure?

I thought we were here to help each other. Please correct me with researched evidence otherwise, I don't find this helpful at all! Please qualify!


Ross

Chicago Dave: Regarding your post of 6/9/13 comparing the relative prostate size of GG patients vs that of Dr. Baglia, I note the following info from Dr. Baglia from an April article on his results.

"The average prostate volume before the procedure was 77 cc, and among the few patients who have reached the 6-month follow-up there has been an average 18% decrease in prostate size."

http://www.medpagetoday.com/MeetingCoverage/SIR/38493

I am very much interested in how our 2 resident PAE patients do. Prostate enlargement is both a function of hypertrophy (enlargement of the gland due to inflammation) and hyperplasia (increase in number of cells/proliferation of cells). For the prostate to shrink 50% within the first few months of prostate embolization would be a remarkable achievement. Yet according to the article, an average decrease after 6 months was just 18%. No doubt that some of these early patients might have had a severe long term condition with catheterization, prostatitis and complications from a compromised immune system which would increase their recovery time and impede the results.

I am trying to understand the mechanism for the reduction of prostate size during PAE. It would seem that "strangling?" or "starving?" (Gat's term, not mine) the blood supply of both prostatic arteries would bring less free testosterone into the prostate. Now perhaps the prostate does not need so much blood and receives an adequate amount of nutrition and oxygen to survive and flourish from auxiliary veins. We know the body can survive with one kidney, with fewer lobes of the liver, etc. And previous embolizations, although temporary of the prostate artery (to stop bleeding) have been successful. We know embolization has been used to cut off the blood supply of uterine fibroids to shrink them very successfully. What we do not know is the long term consequences of PAE just as some might say we do not know the long term consequences of the Gat procedure (despite 6 years).

In any case, I applaud all who have had the wherewithal to try either procedure as opposed to TURP, Greenlight etc which in my opinion are truly barbaric. We are all pioneers! I would love to see the day when a urologists income is reduced in half. My best regards to all.

Chicago Dave: Thanks for the website. I almost signed up for the PAE but I decided to find out more about G-G.

Ira: Woo-hoo! You found three of Dr. Gat's Greatest Hits. They are must-reads for folks considering his procedure. -dave

Dave,

I have my 2-week telephone follow up with Dr. Bagla this coming Wednesday, I'll ask him about the theoretical basis for prostate volume reduction after PAE. I think IIRC that Dr. Bagla has seen better numbers so far than the cited figures above.

Martin, I agree that PAE likely would bring less free testosterone into the prostate and wonder how relevant that is to the effectiveness of the procedure.

Post Edited (Ross-p) : 7/5/2013 9:00:06 PM (GMT-6)

Ross-p said...
- the prostate will "stew" in used blood. -

As we are all trying to find and discuss effective alternatives to barbaric invasive resections and other potentially destructive surgeries, can you please qualify what appears to be a negative, unscientific and inflammatory statement about what is proving to be be a highly effective and minimally invasive alternative along with the GG procedure?
Ross

Ross, please accept my apology. Ross, I am among those considering just what to do. As Dave pointed out, sometimes short-hand descriptions are susceptible to misunderstandings, and that just should have been anticipated. I should have expanded on the explanation. Here is what I wrote so that it appears on this page:

"By the way, based on my reading of this forum and other websites, I've concluded (as a non-expert on medical questions) that PAE should only be considered if varicocele is not in play. It seems to me that PAE "starves" the prostate of blood, and therefore nutrients, while G-G reduces the chance that the prostate will "stew" in used blood."

Regarding the first part of my explanation, I think there is no argument. That is, PAE is intended to reduce the flow of fresh blood to the prostate, with the expectation that the prostate will then reduce in size. Pretty straight forward, and Not a bad theory. If you, rphguy and others have good results, and negative unintended consequences either do not exist or are tolerable, PAE may prove to be a very good way to go.

As I understand the Gat-Goren theory, varicose veins in the subject area (in and around the groin) can lead to various problems, including BPH. That is, just like lower leg ulcers are often caused by varicose veins in the legs, problems can occur in any part of the body that suffers from venous insufficiency. Thus my reference to the prostate, or any other part of the body, "stewing" in used blood. (There is another factor involved, namely pressure exerted by the "pooling" blood. Note, I'm using quotes around "pooling" to indicated that that is a short-hand way of describing the source of pressure caused by venous insufficiency.)

Ross, no inference should have been drawn that I was indicating that PAE increases the risk that veins will fail to port used blood away from certain areas. What I did say is that the G-G method is intended to address that issue.

What I said regarding the PAE method applies to the G-G method: if men achieve good results from the G-G method, and negative unintended consequences either do not exist or are tolerable, it may prove to be a very good way to go.

Ross, to be clear, I hope you and anyone who tries the PAE method have excellent results.

Ira

Post Edited (Skateman) : 7/6/2013 11:59:56 AM (GMT-6)

Martin Victor,

Could you contact me at yudeng2004 (at) hotmail (dot) com? If you have time, I would like to speak with you about the mechanics of the gat-goren procedure as you seem to have a firm understanding of it.

Thanks!

Note: Internal Spermatic Veins....are ISV's not ISM's.

Martin and folks:

Thanks so much for your explanation on the fluid dynamics underlying the enlargement of the prostate following the failure of the ISV one-way values. It was very good, and I'm sure a lot of forum readers will appreciate it. Dr. Gat has a solid explanation for the etiology of (1) prostate cancer, (2) enlarged prostate, (3) overactive bladder, (4) male infertility, and (5) low testosterone. The first three conditions are caused by high pressure and hugely inflated levels of Free Testosterone in the prostate and bladder—12,000% higher than normal as you said). The fourth and fifth conditions are apparently caused by the lack of flow of fresh blood to the testes. The sixth symptom in this complex is (6) the distended veins of the scrotum, which is sometimes referred to as “varicocele”...especially if the distended veins are conspicuous.

Enlarged prostates have been treated for a long time by reducing testosterone activity. In veterinary medicine, old male dogs often suffer from enlarged prostates, which affect how they walk. A common treatment is castration—ouch!—but the prostate shrinks to normal size in a few weeks. Dr. Gat’s theory is a great explanation for the success of saw palmetto and finasteride in reducing the size of the human prostate. What isn't appreciated by the establishment is the hugely elevated of testosterone that these drugs must cope with. The G-G procedure reduces testosterone a third way: by providing better circulation through the testes, prostate and bladder and thus diluting its concentration.

[As an aside, let me comment about guys who are trying to boost their natural testosterone with injectable hCG (human chorionic gonadotropin), which stimulates the testes directly to produce more testosterone. If Dr. Gat’s theories are correct, then some of these guys could be running the risk of elevating already-high levels of testosterone in the prostate and bladder. This would occur if they had varicocele—which Dr. Gat believes to be very common. ]

I find Dr. Gat’s theory to be extremely elegant. It unifies a bunch of seemingly unrelated symptoms in older men and explains them as different manifestations of a common underlying circulatory problem. Last week I received an email from an acquaintance reporting the progress of her husband, who was being treated for prostate cancer discovered six years ago. Even as he struggles against the cancer, his doctors discovered a new problem: nodules in the bladder, believed to be 85% likely to be metastatic (he is awaiting biopsy results). His doctors told him that the bladder nodules are completely unrelated to the cancer; just two unfortunate strokes of bad luck. But readers on this forum already know the hidden, subterranean connection between some prostate and bladder problems: the high levels of testosterone both can share from ISV value failures. It would be great if G-G could help my friend’s husband, but once the cancer becomes metastatic, there are fewer options. Sad.

Back to Martin's post: Martin, I went through that reasoning myself in late 2010, and even queried Dr. Gat on some of the fine points. I've totally forgotten the details that you've so kindly laid forth to remind us. I remember that the circulation of the lower abdomen is very complicated, and that there are even anatomical differences among people. I remember reading that the elevated pressure caused by the failed ISV valves causes venous blood from the testes (read: high testosterone blood) to *backflow* into the prostate. I don’t remember the details, but if blood is traveling “eastbound” on an “westbound” artery (or vein), you just know it can’t be a good sign.

The other part of Dr. Gat's achievements that really impresses me is that he discovered a *treatment* for the problem. I found this to be an almost unbelievable breakthrough. I mean, researchers are always discovering plausible explanations for all types of maladies, but they seldom discover effective treatments at the same time they propose explanations for the cause. That generally comes later--much later. But Dr. Gat has pioneered a treatment for the malady explained by his theories! That treatment is to block the circulation of blood through *both* intra-spermatic veins (ISVs). Treating both ISVs is important: Even in one-sided Type 3 varicocele, Dr. Gat will insist that both ISVs be sclerotized (closed with chemicals), though urologists often just treat the one side.

The question that sometimes comes up is, How can closing the drainage outlet possibly improve drainage??? As you pointed out, Martin, there are *alternative* *routes* for the venous blood to return from the prostate and bladder to the heart. Dr. Gat sent me emails with detailed math in June 2011 to explain the fluid dynamics behind his theories. He also explained why shutting down the ISV path improves drainage in the other routes. This was right after my procedure, and his emails helped reassure me and give me hope. I don’t think I ever totally “got it”, but hey!—I'm getting good symptomatic improvement so I no longer worry about how the fluid dynamics works. By the way, Dr. Gat was uniquely qualified to come up with that insight: He has a Master’s degree in engineering and “worked as an engineer in hydraulics and control systems during the late 1960s”, according to the bio posted on his website.

I’d also like to address the “varicose vein” explanation of enlarged prostate. I’ve heard this theory in a couple of places, most recently Skateman’s recent post. The term “varicose veins” conjures up a vivid mental image that can be used as a personal symbol of “stagnant blood.” If such an image helps readers visualize the problem, then go with it. But realize that Dr. Gat’s explanations are much more precise than positing varicose veins in the pelvis (see below).

It occurred to me, Martin, that between us we are the perfect the G-G patient: You have the good levels of testosterone, and I have the good improvement in urinary symptoms. It’s too bad we can’t pool our respective improvements.

-dave

P.S.: Martin, your link about PAE was interesting. Sure enough, they said “80%” reduction in prostate volume, not “18%”. They show the plastic beads that are injected into the prostate artery.

P.P.S.
Here’s Dr. Gat’s reply to one of my questions in June 2011.
The abbreviations in his reply—DV, VV, IVC—are all all appearing in a figure in his paper “Reversal of BPH by Super-selective Intraprostatic Androgen Deprivation Therapy”. I think this same figure appears in one of the papers Skateman found.

“40mgHg” is a pressure: 40 millimeters of mercury.

Dr. Gat wrote:
========================================

David

Your question is excellent. So far we explained hydrostatic; now fluid-dynamics.

pls. look at the drainage system in the article - you can see that the prostate venous drainage – "Santorini" (plexus) veins, is connected together with the DV that arrives from the testes and both are inserted in the VV (Urinary Bladder venous drainage). VV is connected directly to the IVC – inferior vena cava – which has the vacuum power exerted by the pumping of the heart and chest movements. So when we eliminate (by the treatment) the 'illegal' hydrostatic pressure that was created by the destruction of the one way valves in the ISVs, there is no pressure gradient between the testicular and prostate drainage systems hence there is no illegal (pathological) back-flow from the testes (carrying huge concentration of free testosterone) to the prostate, and all the flows in the veins DV, Santorini, VV now flow jointly as should be, normally and physiologically, (exactly as before the one way valves were destructed) and upward against the gravity, by the powers of the vacuum originated from above (heart and chest).

The pathological 40mmHg in the ISVs that produced all the problems do not exist after our treatment. Hope i explained to you.

regards

Dr. Y Gat
=========================================

Well, I think THAT should clear everything up. Which is good because there will be an exam Wednesday.

After this reply, we continued exchanging emails. But after this point, things started to get rather technical! And I soon got lost. But notice that nowhere in his explanation does the phrase "varicose veins" appear.

Ira,

Congratulations! You caught me out. So have you scheduled the TURP yet?

This is cutting-edge medicine, and you're going to find a lot of little contradictions in terminology and such until the entire field gets settled. Then they'll be one Single Big Explanation for what's happening that everyone will be forced to subscribe to. Until then, lots of little inconsistencies, mistakes, consistency and other types of generalized fog.

I don't know why the term "varicose" appears in the patent, but I can't challenge it. I disagree with your conclusion that "varicose veins are the heart of the problem," but this is a terminological dispute we shouldn't pursue. If "varicose ISV" is taken to mean "ISV without working one-way valves", then it's just a terminological issue. As long as the focus remains THE ISVs THEMSELVES, and not other veins, I think your terminology is fine.

You are probably right in hinting that my use of the term "varicocele" might have been a little loose. I was adopting the convention that I heard in conversing with Dr. Gat. "Varicose scrotal veins" are caused by--and imply--"nonworking one-way valves in one or both ISVs". These are logically equivalent for practical purposes in that the presence of one implies the presence of the other. Context is usually sufficient to distinguish whether the important condition is the one in the scrotum or in the ISVs. But for exact communication this is ambiguous. I will grant you that. Recently in my posts, instead of writing "varicocele," I've begun spelling out the condition: "distended scrotal veins" versus "ISVs with incompetent one-way valves" (or "varicose ISVs"). I think this makes my meaning clearer.

If you read these documents with biblical literalness, you could get confused. Two little points of possible confusion are: (1) The patent's mentioning that this procedure could be done on one or both ISVs. In practice, they do it on both ISVs. (2) The dictionary definition hints at the layman's definition of varicocele as the "bag of worms". That's Type 3 varicocele. There are also Types 1 and 2. The underlying condition is the faulty one-way valves in the ISV(s). In practice, the diagnostic radiologist diagnoses: Type 3 if it's visible; Type 2 if it's not visible but can be palpated (felt); and Type 1 if the scrotal veins are bigger than a certain amount (it might be 2 millimeters in diameter, but I'm not sure). The doppler color ultrasound can also track the direction of flow of blood through veins. I don't know more particulars.

I've hear the term "varicocele" used in three different ways:
(1) Type 3 Varicocele ("bag of worms" in the scrotum). Used by: urologists, layman, dictionaries
(2) Distended or varicose scrotal veins. Used by: diagnostic radiologists, precise researchers
(3) "Varicose ISVs" or "ISVs with faulty one-way valves"--a condition whose presence is often indicated by (1) or (2) above. Heard: in connection with the G-G procedure. But this might have been a misunderstanding on my part. If so, my bad. I promise not to use it this way in the future.

You are developing a set of terms and personal symbolic images that help you get your mind around these theories. There are thousands of physicians--we could name specialties, but we won't--that haven't begun to get to that point yet. (I have another email from Dr. Gat deploring the level of understanding of the average physician who comes across his papers.) I will agree with you that the terms and images associated with "pool" and "stagnant" touch on what we're trying to describe is happening down prostate way. (The patent does talk about blood "reflux" so that gives you yet another term to play with.)

Theoretical posts like this tend to generate more heat than light. Sigh.

-dave

Post Edited (Chicago Dave) : 7/8/2013 1:07:57 PM (GMT-6)

Ira,

Just joking about the TURP. But I'm glad you found the discussion useful. Other readers might, too.

I also agree that there are problems in *both* terminology and concepts, and that these are hindrances to communicating with family and friends with these problems. Please let me know whether it helps to get these concepts across by using the example of varicose veins in the legs.

There's a cascade of events involved here:
. ISVs valves fail==>
... circulation disrupted by pressure changes/reflux/stagnant blood/etc+varicose scrotal veins==>
..... high concentrations of Free Testosterone in blood in the prostate (and high pressures)==>
....... prostate enlargement.
That seems a mouthful to get across.

I expect that your friends will mention this to their urologist who will assure them--as mine did--that
(1) they don't have "varicocele" (that is, Type 3 Varicocele) and
(2) theories about "varicose veins" causing BPH are totally bonkers. At that point, they might be too abashed to push the point. Urologists also dismiss Dr. Gat's theories out of hand because they've been doing varicocele repair operations (for "bag of worms" Type 3 Variocele) for years, and it doesn't affect either prostate size or male fertililty. (They do different a operation, and they do it on just one side.)

Our PAErs will have to address your other speculation. I was under the impression that the PAE doctors were "agnostic" on the underlying cause of prostate enlargement: PAE should work regardless for the reason for the enlargement.

-dave

Ira,

On testosterone: Yes, indeed. He markets his procedure for the express purpose of increasing testosterone: It's one of the three tabs on his website, along with Male Infertility and Prostate. He has published papers claiming 40% increases in Total Testosterone and 70% increases in Free Testosterone, on average. I think the mechanism is simply the increased fresh, oxygenated blood to the testes. The same mechanism would explain why Male Infertility is improved.

The G-G procedure improved my mood, which I attribute to increased Testosterone. It's hard in my case to conclude anything directly about the effect on my T levels: My T levels were EXTREMELY variable before the procedure, but have stabilized now.

I'm sorry for your friends who underwent "traditional" therapies. I researched those, and concluded they were not as wonderful as my urologists were telling me. So I went on the Internet in Fall 2010 and learned about this nutty doctor (he trained as a gynecologist!) in Israel named Yigal Gat. He had this whacky procedure that he claimed treated enlarged prostates and practically everything else. It was a revelation that I had never imagined. So I emailed this Dr. Gat and, miraculously, he answered me! He had this totally off-the-wall theory about failing veins in the abdomen or some such nonsense. But he was the only one able to explain both my prostate problems and my low testosterone. He also diagnosed me--from half-way around the world without even examining me--as having "varicocele" (=distended scrotal veins). This was utterly preposterous since a string of doctors had examined me previously and said I didn't. I was finally able to finagle an appointment with a diagnostic radiologist while abroad. What do you know? The radiologist told me indeed I had Type 2 Varicocele (=palpaple distended scrotal veins). And on 30 May 2011 I had the procedure in Tel Aviv.

-dave

Well, you boys are WAY ahead of me on the technical side of things - as my father said ~57 1/2 years ago to my Mom:  "Don't tell me about the labor pains; just show me my baby!"    As a slight aside, I'd be curious to know if any of you boys have also experienced (or currently experience) either varicose veins in the leg(s) and/or hemorrhoid(s)?  In trying to apply the "dynamics" of both procedures to myownself, vis a vis which would be a better approach for ME to take, *I* am leaning towards the G-G method.  I have a L-O-N-G history of "varicose issues", to wit:  Hemorrhoids - several, dating back to my early 20's, with at least two surgeries to correct/remove; removal of right superficial varicose vein in my right leg in 1996 (at the age of 40); removal of left superficial varicose vein in my left leg in 2010.  Both leg surgeries "capped" these respective veins off in the scrotal area; both done by "general surgeons".  Co-incident to the second surgery, my PSA numbers began to rise...   Maybe NOT a "coincidence"...

Of course, BOTH the urologists that I've seen (and fired!) have "dismissed" this suggestion with respective waves of their hands.  Now I'm no doctor (I just play one on TV ), but from a lay-man's perspective, doesn't it seem POSSIBLE that the tying off of BOTH superficial varicose veins COULD have caused/exacerbated my (known) "mildly enlarged" prostate due to the theories discussed by Drs. Gat & Goren?  Seems logical to me; as such, that's the procedure that *I* am leaning towards - thoughts from the group?