BHP and Prostatic Artery Embolization (PAE) - MY STORY

[OMI100]

Long story short…

• Large prostate.
• NO PCa.
• Getting up at night every 1.5 to pee.
• Getting old with that.
• Researched minimally invasive procedures.
• Procedure covered by insurance.
• NO DICING AND SLICING because of possible sides!
• TULSAPRO looked good but insurance would not cover.
• Researched PAE and it met the above goals.
• Research came up with 3 or 4 DRs that stood out.
• I picked one within “road trip” distance, Dr. Isaacson and UNC.
• Ari J. Isaacson, M.D.
• Cold called and said I was interested in the procedure.
• TELCON was set up w/Dr. Isaacson.
• Told him my history and sent some backup med data (MRI, etc).
• Appointment for the procedure was this last Monday (26OCT20)
• First one in!
• Arrived at 0700 and checked in.
• Taken to preprocedural area and prepped and had IV thing inserted in right wrist.
• Staff was GREAT!!!
• DR. Isaacson came in and clearly went over the whole procedure step by step and CLEARLY explained what to expect at each step in the procedure.
• He left and a short time later (0830ish) I was moved into the procedure area.
• Additional preprocedural stuff done.
• IV connection was there if I needed ANY “feel good meds” if I needed to calm down at any point in the procedure.
• I did not need any “feel good meds” at all so I was totally cognizant and awake for the ENTIRE procedure.
• DR. came in and explained again the steps, one at a time.
• Lidocaine shot in the left wrist where the cath was going in. A LITTLE sting but not even worth mentioning.
• Next a shot of meds to keep arteries open. A LITTLE warm feeing lower body but not even worth mentioning.
• Next cath going in.
• Did I mention the LARGE screen to my right that I could watch the cath going in and around
• I think when the cath was routed through my heart it felt a bit strange but again NOTHING to write home about.
• Snaked the cath to my prostate and inserted a small cath inside the first cath that would be able to get into smaller arteries in my prostate.
• A shot of contrast meds was injected (and the staff moved out into next room) as an X-Ray was being taken.
• Next thing on the screen was a 3D image of the prostate and ALL the arteries and blood vessels leading into it. The picture could be rotated 360 to let the DR. see the 3D image and make sure the beads would be going into the right prostate artery.
• Staff kept asking if I was O.K. and needed anything
• Snaked the smaller cath into the right artery and injected the beads.
• Pulled the cath back out and then went to work on the other side
• AT this point if you have seen one side done than it was the same on the other side…. So Borrring Seen it once already
• The Dr. finished up and removed the cath.
• Placed a plastic like tourniquet thing with a pouch on it on my left wrist where the cath went in so that they could inject air into the pouch and fill it up.
• That put pressure on the cath site and I had to wait as they slowly removed air over time and the pressure on the wound site.
• DR. came in one more time and clearly explained any possible sides and asked if I had any questions.
• 3 scripts were provided. A prednisone pack, 3 days of Bactrim and a few pain pills if needed.
• DR. said Monday night would the worst and things start getting better on day #2.
• DR. said should start seeing improvements in around 2 weeks and up to 6 months out.
• THE ABSOLUT WORST PART OF THE WHOLE PROCEDURE WAS WHEN THEY PULLED THE TAPE OFF OF THE IV HOOK-UP ON MY RIGHT WRIST
• Was walking out about 1100ish and went to a Waffle house for breakfast.
• Was going to stay in the area for another day “just in case” but the weather was a factor so I had left for Atlanta on TUE morning for a night there.
• Worst issues on the way to Atlanta were the same as I already had. When I felt the need to pee I better get thee to a latrine.
• Spent the night in Atlanta and drove home on WEDS.
• Will start tracking the number of times up at night to pee and see any positive impacts (I hope).
• Everyone is different and that’s my story YMMV
• BTW NEVER needed any of the "going away" pain meds.

 

[Joe Sixpack]

Awesome writeup. I'm really looking forward to hearing your progress.

Two questions for you....
You mentioned....I think when the cath was routed through my heart it felt a bit strange but again NOTHING to write home about.
Why do they need to run a cath to your heart?

Why did you choose PAE over Rezume (water vapor)?

 

[OMI100]

My guess. I did not think the left wrist artery had a direct line to the femoral artery but if it does that was what I was feeling, the cath changing lanes so to speak. Someone with more vascular knowledge might be able to answer that. What ever way it went I only experienced a very minor funny feeling for a few secs.

I was looking for the least invasive procedure I could find. I think Rezume pokes holes through the urethrae to shoot the steam in. PAE does not poke any holes or even mess with the urethrae. Less sides.

Also not sure on the Rezume side if a greater chance of messing up nerve bundles that you do not want messed up.

PLUS you have to have a cath installed AFTER the procedure for a few days and then another trip back to the DR. to have it removed.

I got up and walked out with NO holes poked into my prostate and urethrae and NO installed cath.

This procedure seemed right for me and my current condition. It works well for large prostates. I have one

If it works I am a happy camper. If not I will revisit other options later.

 

[Blackhawk]

Thanks for the story @Orrin Israel , Please keep us updated over the longer term!

Just amazing what they can do with catheters. I have no idea how they can steer the darn thing through the heart then into the correct arteries in the prostate.

Did you ask the question about any limitations of future procedures after PAE?

 

[OMI100]

Answers from the DR.

1. We do not go through the heart. The descending thoracic aorta goes by the heart but not through it.

2. The beads do not prevent you from having any other procedure.

 

[broker]

Thanks so much for sharing!
you mentioned the doc said “ the first night will be the worst ” , What did he mean by that and was there any pain?
how long did the procedure take?
do you take flomax or any other med until the procedure starts to show results?

 

[OMI100]

1. Everyone is different and have different symptoms and most likely a bit different procedure.
2. Dr. did not go into great detail on 1st night being worst but covered a number of situations that could happen.
My guess is each persons body will react to a significant part of blood flow to your prostate being cut off differently. He did mention that the bladder might kick in more often due to the actions going on in the prostate. Also there was the possibility of some prostate swelling as I recall. All minor sides.
In my case the ONLY pain was removing the stuff that was taped to my wrist and the cath site is still a bit sensitive. Nothing to write home about, just need to keep an eye on it and let it heal.
There was a mention of a need to cath in vary rare cases where the prostate swelled up and closed off the urethra. I had no issues like that.
3. I had tried all the meds for BPH and it was the same if I took them or not with the exception of 5mg Cialis. I stayed on that and am still taking it now.
4. I was walking in to the hospital at 0700 and was walking out to go to lunch at noon I would say the actual procedure in my case (time on the table) was less than 2 hrs. Again dependent on each persons situation.
5. Impact to date is increased need to pee I think the prostate and body is adjusting to the loss of blood to portions of the prostate. Once that settles down I think improvements will start. Dr. did say about 2 weeks to start seeing improvements.
6. Biggest issue 5 days post procedure is to make sure I am near a latrine to pee at all times

 

[broker]

So you had no pain during the procedure?
what about returning to normal activity such as weight lifting or running?

 

[OMI100]

NO PAIN during the procedure.
I was awake, with NO meds, for the entire procedure.
Cath could have gone in the leg or wrist.
The Dr. used my wrist.
Felt the shot of lidocaine into the wrist where the cath went in.
Felt minor reaction to the drug that was used to keep the arteries open and felt a minor reaction to the contrast drug for the 2 x-rays. No biggie.
Like I said above, in my case the worst part of the procedure was the removal of the stuff taped to my wrist

Light duty for a few days for the left wrist / hand to give the cath site artery enough time to heal. As I recall it was like around a week of light use.

UPDATE
Forgot to mention hematoma (burse) at the cath site. Looks waaaay bad but just blood remnants rising to the surface. NO PAIN just big 'ol blue area

 

[broker]

How is your progress thus far? Is your stream noticeably better?
any pain?

 

[OMI100]

UPDATE 1
O.K. - 12 DAYS POST PROCEDURE
After the procedure there was some discomfort (some say burning) when I had to pee and frequency was ramped up (like very 30mins to every hour).
That started to diminish about 2 or 3 days ago.
Now peeing with MOSTLY no discomfort and nearing zero discomfort.
Frequency is getting longer apart now. Now running in the hour to almost 2 hour apart at night.
Stream is strong.
Bruise on arm is slowly disappearing.
It seems body has gotten used to the loss of blood to portions of the prostate now.
I hope to start seeing a continuation of the positive impacts like less frequently having to pee at night.
More to follow

 

[DragonBits]

Thanks @Orrin Israel for the detailed story.

I will likely get PAE in the future, but I doubt I qualify for it right now. My getting up at night is not consistent, usually I get up often3-4 times a night, sometimes not at all. Often I wake up because I have a hard time sleeping all night long, I go to the bathroom mostly because I am already up not because an urgent need to go.

If I could, I would get PAE right now just to prevent future problems and lower my PSA, my prostate was estimated at 60CC via DRE, no imaging done.

 

[OMI100]

I am not sure how reliable a DRE is when one has a large prostate (mine bein 3X yours).
I dont think ANY of URO's EVER said anything about how large my prostates was. It was only after my MRI W/Bush that he addressed the size of mine.

 

[broker]

Is the prostate inflammed? How does that make you urinate? What is causing your to urinate so much?
are you using any meds?

 

[OMI100]

As I recall my prostate was pushing up on the balder and the bladder may have been holding back a bit of urine so the bladder thinks it has to empty again.
There may be some swelling of the prostate after the PAE that goes down over time.
I think the frequent peeing was just the body going WTF just happened!!!!
"Mabey if I pee a lot it will all go away"
Everything seems to be improving over time.

 

[broker]

How are things progressing? Flow ?
frequency?
Any discomfort or anything strange?

 

[Mountain Man]

I have been told this type of procedure would help me, but have declined and I do not want sex life to be hurt. Very interested to know how sex is post recovery.

 

[OMI100]

12 DEC update.

Had follow-up with the DR last week.

Frequency was around every 30 mins directly after the procedure for a number of days.

Slowly increasing to longer intervals.

From average of 30 mins to 1 hour to 1.5 hrs to recently 2 hrs.

Initial 30 min freq was the body going WTF just happened

DR said should continue to see improvements in freq.

He is hoping it will get down to 2 or 3 trips to pee at night. That will be a BIG improvement of where I was at.

Mr HAPPY is working fine. There should be no impact as this procedure only impacts the portion of the prostate that has the blood supply cut off. I may send an email to the DR to confirm. Unless a nerve bundle goes through the middle of your prostate, there should be n o impact.

I will keep updating till the 6 month window.

 

[DragonBits]

I have been told this type of procedure would help me, but have declined and I do not want sex life to be hurt. Very interested to know how sex is post recovery.

I was assuming their would be no affect on sex life as this should gradually shrink the prostate over time.

Of course, any surgery could have unintended consequences.

 

[OMI100]

I have been told this type of procedure would help me, but have declined and I do not want sex life to be hurt. Very interested to know how sex is post recovery.

From my Dr.:
"PAE does not effect erectile function or cause dry ejaculation. The only effect it may have is to reduce the volume of ejaculate. This only happens in some patients."