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Prostatic Artery Embolization (PAE)
Old 04-11-2016, 04:58 PM   #1
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Prostatic Artery Embolization (PAE)

Hi, has anyone had this procedure? Would you be willing to share outcome?

Has anyone researched PAE and like to provide information.

For those interested, here is a link about the procedure Prostatic Artery Embolization (PAE) — heartandvascular
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Old 04-11-2016, 07:02 PM   #2
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I haven't had it but I read about it about a month ago just a week or so before my annual prostate exam and mentioned it to the urologist. He had heard of it but wasn't well versed in it since it's super brand new.

Personally I like it. Since I cannot take most antibiotics I am very concerned about anything that might cause infection and that includes surgeries great and small, so this really caught my attention.

On an semi-related note, while talking about PSA levels, the Urologist said that the current "state of the art" thinking is, if your PSA is 1.5 or less at age 60, your chance of ever getting prostate cancer is extremely small. Just thought I'd share that.
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Old 04-11-2016, 07:13 PM   #3
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The subject of prostate problems, whether benign (BPH) or cancerous, should be of interest and concern for all retirees. On the cancer side, 180 thousand cases, and 26 thousand deaths per year. The second worst type of cancer for men.
As for the BPH, one in seven men will suffer sometime during their life. Six in ten cases in men over age 65.

Surgery, medication and early diagnosis can mitigate the effects, but knowing about the possibilities and symptoms is very important.

While I can't speak to the new PAE surgery, my own recent experience makes me want to see the subject discussed.

With no warning, and no PSA or other testing indicating a problem, over a 24 hour period last year, I experienced urinary retention, which seemed minor, until it became apparent that "nothing was happening". Despite walking and drinking fluids, the problem didn't go away, and gradually gave way to pain, and eventually some dizziness, and double vision. A panicky trip to the emergency room, and an alert nurse used a catheter to relieve the problem... just in time. The ER doctor said it was just a matter of hours, or less... before the bladder might burst, or a back up could have caused irreparable damage to the liver or the kidneys and possible death. I had no idea, and had never heard of this before.

No cancer, but "so much" for benign.

The after-diagnosis decision... operation or medication. Low risk for minimal corrective (TUNA), (TUMT), or (UROlift)....TURP, TUIP, laser etc...
The doctor suggested an operation, but after looking at the options, I chose the medication... "tamsulosin" (FloMax)... cost w/o insurance would be about $75/mo. Now a year later, a nuisance, with no long term cure, but so far, without the surgery risk, however small.
Here's one website of many that discusses the general subject of prostate problems. IMHO... worth a look, given the odds that increase with age...

Enlarged Prostate: Prostate Surgery Types, Recovery, Results, & More

Anyway, the PAE sounds promising, though it doesn't look to be generally available. Some discussion of it here:
http://patient.info/forums/discuss/h...zation--301859
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Old 04-11-2016, 09:24 PM   #4
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imoldernu, you were lucky. I too suffered the urinary retention with no forewarning 2 years ago during a long weekend away. To make things short, a trip to the local hospital and they tried 4 or 5 times to insert the catheter to no avail. A 60 mile ambulance ride to the big city and a bunch of Morphine, they got one installed. I got home later that day and had a visit to a urologist the next day. He offered several choices but I (we) chose to have the catheter removed to see what happened. Sometimes it works to get things going. The next day, I was stopped up again. Back to the Urologist and he tried to insert another catheter and NO-GO. He then tried inserting it using some sort of scope to guide him. NOPE again. I was immediately taken over to the hospital for emergency TURP surgery. He considered TURP "the Gold Standard" for BPH. Other procedures were not as good a long term solution in his opinion. I had no time to research and decide for myself.


This can surprise anyone even if you are aware of the condition. And, as in my case, catheter installation is not always an option.


Further discussion along these lines are well warranted IMO.
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Old 04-11-2016, 10:35 PM   #5
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Were either of you two having any of the typical, troubling prostate symptoms before the sudden retention? Or were you just running along fine until the big moment?
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Old 04-11-2016, 11:06 PM   #6
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Quote:
Originally Posted by razztazz View Post

On an semi-related note, while talking about PSA levels, the Urologist said that the current "state of the art" thinking is, if your PSA is 1.5 or less at age 60, your chance of ever getting prostate cancer is extremely small. Just thought I'd share that.
This is good news for sure. Some of these maybe type health issues i'd just as soon put aside, especially like this one if the risk is very low for me.

Ha
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Old 04-12-2016, 03:15 AM   #7
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Originally Posted by Imoldernu
With no warning, and no PSA or other testing indicating a problem, over a 24 hour period last year, I experienced urinary retention, which seemed minor, until it became apparent that "nothing was happening". Despite walking and drinking fluids, the problem didn't go away, and gradually gave way to pain, and eventually some dizziness, and double vision. A panicky trip to the emergency room, and an alert nurse used a catheter to relieve the problem... just in time. The ER doctor said it was just a matter of hours, or less... before the bladder might burst, or a back up could have caused irreparable damage to the liver or the kidneys and possible death. I had no idea, and had never heard of this before.
This is similar to how my father died in 2001 at the age of 71. His kidneys and liver shut down after backup of urine in the bladder, but it was only indirectly related to the prostate. He had undergone radiation treatment for prostate cancer a few years earlier, and the radiation had ruined the lining of his colon and bladder. The year after the treatment he had over 40 units of blood transfused with all the bleeding he was doing in the colon. Eventually they got the bleeding there under control, but he eventually bled so much in his bladder that it clotted and blocked the egress of urine. The catheter didn't help, and after getting this temporarily dealt with in the ER a few times, finally his kidneys and liver shut down from the backpressure.

Urine retention can be a very serious condition!
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Old 04-12-2016, 05:27 AM   #8
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Ughh - and here I thought my BPH was simply annoying :-(. Thanks for passing this info on.


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Old 04-12-2016, 05:50 AM   #9
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I read somewhere that after age 80, standard blood tests don't even measure PSA unless Dr. specifically requests it. The assumption seems to be that if you haven't gotten prostate cancer by 80, you will die of something else anyway (not sure I agree with this, what with so many folks living to 90+ these days).

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This is good news for sure. Some of these maybe type health issues i'd just as soon put aside, especially like this one if the risk is very low for me.

Ha
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Old 04-12-2016, 06:11 AM   #10
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I've had an artery embolization procedure to block blood vessels supplying blood to uterine fibroids (a benign growth in the uterus). I think it's pretty much like a stent procedure. There is some radiation exposure for the fluoroscopy. They went into an artery at the groin and then use little pellets to block targeted vessels. I had some nerve irritation at the entry area that went away after ~6 weeks. It was successful in that the fibroids stopped growing and shrunk a little due to tissue death. There is pain management for 24 hours because the tissue death causes severe cramps, but I don't remember much. You can look up about UFE just to see something similar.
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Old 04-12-2016, 06:51 AM   #11
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Originally Posted by razztazz View Post
On an semi-related note, while talking about PSA levels, the Urologist said that the current "state of the art" thinking is, if your PSA is 1.5 or less at age 60, your chance of ever getting prostate cancer is extremely small. Just thought I'd share that.
This would be great news for DH.

Although I expect the story is more like "your chance of dying from prostate cancer is extremely small". In other words, whatever developed would be so slow/non-aggressive that it would have no impact on life expectancy.
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Old 04-12-2016, 07:15 AM   #12
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I am so glad you got help in time. Some may think I'm trying to be funny with this post, but I'm not. Men, if you get "stopped up," do not wait until it hurts. We lost one male cat to urinary blockage - he stayed stoic (so we had no clue) until he went mad from the pain, and by then it was too late. Another made a fuss much earlier, and was saved by catheterization. The third afflicted male cat - sadly, catheterization did not work; the vet performed an amputation (yes, that kind) that saved his life. The point being: Humans have more options when something's not right. If you notice something wrong, don't wait to get help.

Amethyst

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imoldernu, you were lucky. I too suffered the urinary retention with no forewarning 2 years ago during a long weekend away. To make things short, a trip to the local hospital and they tried 4 or 5 times to insert the catheter to no avail. A 60 mile ambulance ride to the big city and a bunch of Morphine, they got one installed. I got home later that day and had a visit to a urologist the next day. He offered several choices but I (we) chose to have the catheter removed to see what happened. Sometimes it works to get things going. The next day, I was stopped up again. Back to the Urologist and he tried to insert another catheter and NO-GO. He then tried inserting it using some sort of scope to guide him. NOPE again. I was immediately taken over to the hospital for emergency TURP surgery. He considered TURP "the Gold Standard" for BPH. Other procedures were not as good a long term solution in his opinion. I had no time to research and decide for myself.


This can surprise anyone even if you are aware of the condition. And, as in my case, catheter installation is not always an option.


Further discussion along these lines are well warranted IMO.
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Old 04-12-2016, 07:47 AM   #13
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I can relate to your pain of the urinary blockage - it happened to me when I was preggers with son #2. I was out of town at the time and apparently developed a stenosis. I was in extreme pain when I went to the ER... When they offered the catheter I was so grateful... and they drained almost a gallon. I was told it was something of a miracle I didn't burst my bladder.

My dad had the turp procedure after meds didn't work for him. About 5 years later he had prostate cancer - but it was resolved/cured with radiation. Men - take care of yourselves.
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Old 04-12-2016, 08:20 AM   #14
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In my case, no warning... never a problem before, and the PSA test before , AND after gave a reading of 2.5, which is relatively low especially for my age.

It's now 9 months since the first onset. After the initial problem, had to wear a drainage bag for about a week. After that, have been using the medication. It works, but it does cause a newer problem of more frequent trips to the bathroom, and waking up at night every two or three hours. I may rethink the operation.

Back to the OP... if you missed the link in my earlier post, re the discussion of the PAE... you might wanna go back and read it. There are many, many first person comments on the operation.
Has anyone out there had a "Prostate Artery Embolization??.Thread discussing Has anyone out there had a "Prostate Artery Embolization??

Sometimes, getting older is not so much fun... until you consider the alternative.
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Old 04-12-2016, 08:53 AM   #15
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Quote:
Were either of you two having any of the typical, troubling prostate symptoms before the sudden retention? Or were you just running along fine until the big moment
I was (and still am) getting up once a night. That grew to twice a night about 1/2 the time about a year before "the event". No issues during the day. I had one time that urination was "iffy" about a year before but it was not a recurring problem. No other indications, certainly not a continual forewarning. The night the event occurred I was up all night with the urge but no results. No sooner than I went back to bed, I was back in the bathroom needing to go. By morning, I was in pain. At the time, I was on a long weekend with a group of car builders. One person was up early (6AM) skyping to his GF in Australia. She heard our conversation and was a nurse. She urged us to immediately go to the emergency room, which we did. I am thankful to her advice. I am due for my annual checkup.


For those considering TURP (and some other procedures), Be forewarned. Retrograde ejaculation is much more common than the doctors would lead you to believe. But considering my alternatives, I had no choice. It was take my chances with the TURP or die.....
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Old 04-12-2016, 10:30 AM   #16
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This would be great news for DH.

Although I expect the story is more like "your chance of dying from prostate cancer is extremely small". In other words, whatever developed would be so slow/non-aggressive that it would have no impact on life expectancy.
That's exactly what I was thinking, since I had always heard something like --most-- men over 70 or 75 actually have either cancer or pre-cancerous abnormalities whether they know it or not. But if I never get symptoms, never get diagnosed, and die peacefully in my sleep at 100, or while mowing the lawn on a hot summer day at any age, like, um, what's the problem? But I got the urologist's drift. ie "Stop worrying".
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Old 04-12-2016, 10:35 AM   #17
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This procedure sounds promising. However, a high (17) --but false--PSA led to a prostate biopsy for me.

Good news: biopsy was negative
Bad news: I almost died from sepsis 12 hours after the procedure. Most frightening time of my life!

As such, I'm hesitant to consider further tinkering.
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Old 04-12-2016, 11:13 AM   #18
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This procedure sounds promising. However, a high (17) --but false--PSA led to a prostate biopsy for me.

Good news: biopsy was negative
Bad news: I almost died from sepsis 12 hours after the procedure. Most frightening time of my life!

As such, I'm hesitant to consider further tinkering.
I do not understand (Well, I do. It's money) why doctors insist on treating these things the way a fire department treats a fire alarm. If you have a certain PSA level over time then all of a sudden it shoots up... that ain't cancer. Even an aggressive cancer doesn't grow that fast.

An abnormal psa means you should come back in 60 or 90 days and check it again and track it. I wont go over my history with doctors again here, but whatever they say these days.... I don't believe them. I want medical evidence. Not their opinion. And not "Studies show" or "Current thinking is."

Whatever they try to tell me these days... I don't believe them. For 17 years now I am always right. They are always unmasked as spelunkers. Yawn.
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Old 04-12-2016, 11:16 AM   #19
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That's exactly what I was thinking, since I had always heard something like --most-- men over 70 or 75 actually have either cancer or pre-cancerous abnormalities whether they know it or not. But if I never get symptoms, never get diagnosed, and die peacefully in my sleep at 100, or while mowing the lawn on a hot summer day at any age, like, um, what's the problem? But I got the urologist's drift. ie "Stop worrying".
I don't have time to find the citation now, but a couple of pathologists did sections of every prostate on a man age 75 or over who died from causes unrelated to prostate, in a large hospital. They all had cancerous tissue- 100%.

If this is accurate, it means that a prostate biopsy in a man => age 75 is kind of a matter of chance. It is there, but the needles may or may not get any. Probably depends to some extent on luck, and to some extent on the density of pathological tissue.

Ha
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Old 04-12-2016, 11:19 AM   #20
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I do not understand (Well, I do. It's money) why doctors insist on treating these things the way a fire department treats a fire alarm. If you have a certain PSA level over time then all of a sudden it shoots up... that ain't cancer. Even an aggressive cancer doesn't grow that fast.

An abnormal psa means you should come back in 60 or 90 days and check it again and track it. I wont go over my history with doctors again here, but whatever they say these days.... I don't believe them. I want medical evidence. Not their opinion. And not "Studies show" or "Current thinking is."
Well, I didn't want to get into the details but my PSA had risen from 2 to 17 then tracked back to 9-11 for three years before my urologist suggested the biopsy.

It still is holding at 8-9 for the past 8 years but we've both come to agree that it is a false high and 'normal' for me.
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