Gat Goren, PAE, LUTS, Part 8

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PeterDisAbelard.
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   Posted 12/16/2016 9:59 PM (GMT -7)   
I am starting a new thread for the Gat Goren discussion since there is a limit of 9 continuation pages on the forum before a thread becomes corrupted and lost. Please continue that discussion here.

If you want to read the previous (Part 7) thread it is here:

Whole Part 7 thread: www.healingwell.com/community/default.aspx?f=35&m=3404502
Last (most recent) page: www.healingwell.com/community/default.aspx?f=35&m=3404502&p=9
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Forum Moderator - Not a medical professional

Post Edited (PeterDisAbelard.) : 12/17/2016 8:51:22 AM (GMT-7)


ClapTheHammer
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Total Posts : 104
   Posted 12/20/2016 9:57 PM (GMT -7)   
News from The UK Guardian. Prostate cancer laser treatment could be a game changer for men - A drug that can kill cancerous cells without the side-effects of radical surgery is causing massive excitement for good reason.

https://www.theguardian.com/society/2016/dec/20/prostate-cancer-laser-treatment-could-be-game-changer-for-men

Really does look promising. Original research done in Israel but, nothing to do with Gat Goren who seem to have ..... disappeared.

Post Edited (ClapTheHammer) : 12/20/2016 10:03:25 PM (GMT-7)


Bob_NJ
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Date Joined Jan 2009
Total Posts : 190
   Posted 12/29/2016 2:17 PM (GMT -7)   
I have been taking dutasteride for about 13 months now in order to keep my prostate from growing, and hopefully shrink it. I'm scheduling an ultrasound soon to check my PVR and the size of my prostate. I'm 70 and the prostate was 313g. before my turp in April 2015, and 203g. in Nov., 2015. I haven't had any trouble urinating and my PVR in Nov., 2015 was 32 ml.
My PSA was slowly increasing by about 3/4 of a point a year for the past 5 years. Last November it was 8.7. I knew that with taking dutasteride I had to double my current PSA reading to get an equivalent figure. I just got my PSA result back and it was 1.2 (or the equivalent of 2.4 without the dutasteride), or a drop of 6.3 points. I'm not sure what it means but I thought it was interesting.

Bob_NJ
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Total Posts : 190
   Posted 12/29/2016 2:51 PM (GMT -7)   
I don't know what the procedure is in the UK, but in the US it can take a decade for a new treatment to be approved. This phase three trial was conducted from March 2011 through April 2013, but I don't know if anything else has been announced in the past 3-1/2 years in Europe. The total number of participants for the procedure was 206 getting the treatent, and 28% did not benefit from the treatment.

I'm not sure how this treatment ranks with other modalities like the insertion of radioactive pellets.

Here is a more detailed report from Lancet.

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(16)30661-1/fulltext?rss=yes

Here is a report on the phase 1 and 2 trials in the US, but only with 30 participants.

http://www.jurology.com/article/S0022-5347(16)30587-0/fulltext



ClapTheHammer said...
News from The UK Guardian. Prostate cancer laser treatment could be a game changer for men - A drug that can kill cancerous cells without the side-effects of radical surgery is causing massive excitement for good reason.

https://www.theguardian.com/society/2016/dec/20/prostate-cancer-laser-treatment-could-be-game-changer-for-men

Really does look promising. Original research done in Israel but, nothing to do with Gat Goren who seem to have ..... disappeared.

NJ_Nadja
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Date Joined Feb 2017
Total Posts : 1
   Posted 2/1/2017 10:33 PM (GMT -7)   
Hi! I am interested in contacting Drs Gat/Goren on behalf of my father in order to figure out if he'd be a good candidate for the procedure. Based on the latest posts in this thread it seems that people are having problems contacting the clinic using the email listed on their website. Does anyone know how to reach them?

Frank in Florida
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Date Joined Oct 2013
Total Posts : 27
   Posted 2/14/2017 3:01 PM (GMT -7)   
Double voiding???

I am 3 years out from having my ISV's embolized by a radiologist and doing well. My varicocele has not recurred and my BPH has pretty much resolved. My prostate is smaller on digital exam. I still have urgency which may be due to my mild interstitial cystitis.

Now my question. I also have what I have been calling double voiding but my use of that term may be inaccurate. What happens is, usually after sitting for a long time, I am only able to partially empty my bladder. Then, about 5 minutes later, I have to run back to the toilet to finish emptying my bladder...and it does seem to empty completely at that point.

Do any of you guys have a similar problem? Have you found anything that helps it?

Thanks!

ClapTheHammer
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Date Joined Jun 2012
Total Posts : 104
   Posted 2/23/2017 3:14 AM (GMT -7)   
NJ_Nadja. I just telephoned them at phone 972-3-6139758.

A receptionist answered. So they are clearly still functional.

E-Mail was listed as : GatGoren@gmail.com

Good luck.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 2/23/2017 8:29 PM (GMT -7)   
Hello Frank in Florida

Could you tell me who performed your ISV embolization? I am interested in having it done as well. Is it the same as the Gat Goren procedure? Was it covered by insurance?
Thanks Frank
Howard

Frank in Florida
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Date Joined Oct 2013
Total Posts : 27
   Posted 3/8/2017 7:01 AM (GMT -7)   
Neil: I had my procedure done by South Florida Vascular near Fort Lauderdale. I chose them because their website showed they specialized in venous problems. They have a lot of experience treating varicoceles for infertility. I had a very positive experience with them...nice folks. Check their website.

Medicare paid for mine because I was having discomfort from my varicocele (left only). I paid nada. Even if you are self-pay, I doubt that it would be more than 2-3 thousand.

In my opinion, the Gat-Goren procedure is basically the same as the IR treatment for varicocele. In any case it worked wonders for me. However, it can take more than a year (13 months in my case) for the benefits to show. Three years out I have not had a recurrence and am very happy...I sleep straight through the night most nights.

Good luck!

Frank

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/8/2017 8:36 AM (GMT -7)   
Hi Frank,
Thank you very much for that information. I will look into it now. Could you please tell me the name of the doctor who treated you?
Thanks again.
Good luck.
Neil

Frank in Florida
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Date Joined Oct 2013
Total Posts : 27
   Posted 3/8/2017 10:03 AM (GMT -7)   
Neil: Dr. Julien, who started S. Fl Vascular. Very knowledgeable and very easy to work with. I'm leaving on a trip now, back on Tuesday.

Frank

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/9/2017 8:24 AM (GMT -7)   
Hi Frank,
Is there an email for Dr. Julien where I can contact him directly? The switchboard just wants to set up a consult and they do not understand that I live in Canada and I first want to send him my records.
Thanks Frank.

Frank in Florida
Regular Member


Date Joined Oct 2013
Total Posts : 27
   Posted 3/13/2017 2:59 AM (GMT -7)   
Neil: Sorry, I don't have an e-mail address. Dr. Julien is excellent, but this is a standard IR procedure for treating varicocele and there are probably good doctors in your area (or across the border) who could also do it. Maybe you should get it done before we adopt your healthcare system smile

tgt111
New Member


Date Joined Mar 2017
Total Posts : 6
   Posted 3/15/2017 12:12 PM (GMT -7)   
I've been following this thread for awhile. I like the science behind the GG procedure. It seems to be the real solution to the BPH problem. All the other procedures treat the symptoms...My problem is I can't figure out why haven't any other Dr's gotten into this procedure. I've been looking at this info for 5 or 6 years (I think the procedure has been around for 9 or 10 years..maybe longer) as my prostate continued to enlarge.. I thought in a few years when it's covered by insurance, I'll get it done. Why the mystery with this? You would think it would be the gold standard by now...like PAE is becoming...I'm just speculating now on what's going on with this. Something doesn't feel right. I'm thinking now "Frank in florida" is correct in that the GG is a standard varicocele embolization procedure. The GG Dr's are trying to claim it's their own proprietary technique. I guess this is a good business move by them but bad for us. This is probably why there is a lack of published studies and a lack of data in this area, hence, why other Dr's are not doing it?...No studies, No proof....and GG gets all the business. Maybe the many other fertility /IR Dr's in the US that do the varicocele embolizations don't have the data to allow them to start claiming a BPH cure? Certainly somebody doing the GG procedure here in the US would do very well. I don't get it. Just look at the difference between the "roll out" of the PAE and the GG. Dr. Pisco is all over the net with information. Very straight forward. Doing studies...following up...3 year, 6 year(I think)... no secrets.. sharing his techniques and information with all...Other Dr's all over the world involved... and then there's GG: ???????

I called South Florida Vascular, inquiring about the varicocele embolization that I read about on this site.. I got a call back from a secretary who had no idea what I was talking about. I asked to speak with Dr. Julien or maybe an email. "No you have to come in" was the answer." But, i'm in NJ.. Can I possibly speak to the Dr?"... Not possible... They had no idea what I was talking about.. This is the place that "Frank in Florida" had his embolization done. I can't even speak to a Dr.! I'm going to try again, it's probably just typical screening...Im not in a rush. I was just surprised by blank wall with the staff.

I am considering going with the PAE with Dr. Bagla who called me and answered all my questions..It's also covered by my insurance. If the GG procedure someday finds the daylight, I can still get it done if need be.. Having the PAE done will probably reduce my prostate by 25 to 30 percent ..so in my case, I would go from 55 grams to 37 to 40 grams which still is a slightly enlarged prostate. I've been told a normal size is 25 to 30 grams. I could still get GG done in the future if it ever pans out. I like the science behind the GG but something smells fishy. I also don't blame anyone for getting it done. If I was miserable and comparitively speaking im not (I'm getting up only 1 to 2 times a night with a poor stream and moderate retention), I might shell out the 25K and do it. It's just frustrating believing in the science and not see it go anywhere for years!

Frank in Florida
Regular Member


Date Joined Oct 2013
Total Posts : 27
   Posted 3/16/2017 2:16 PM (GMT -7)   
BPH seems to be associated with varicoceles, and I seem to remember reading that Gat & Goren also believe that. Out of curiosity, does anyone on the group have BPH but no varicocele on ultrasound? After my ISV embolization, my varicocele went away in a month, though it took 13 months for my BPH to improve.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/16/2017 6:29 PM (GMT -7)   
Hi Frank - I gave up with S. Florida but did find a VIR closer to home in Detroit who is willing to meet me for a consultation in 2 weeks. I sent him all my records for review. He specializes in infertility like GG and told me he is quite familiar with the GG procedure but it is considered experimental.
Anyway, he will first perform a scrotal ultrasound on me to confirm varicoceles. I know that GG claim they have never seen a man with BPH who did not also have varicoceles. I know I have at least a Type II (small bag of worms) which causes me some discomfort.
He did indicate he is willing to do the GG procedure on me as long as I know there are no guarantees.
I told him I had PAE last summer at UNC where I had a near-100% assurance of success yet there has been no relief of my symptoms so maybe GG will even out the score!
Thanks for your help and everyone here for the education. I will keep you up to date.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/17/2017 2:53 PM (GMT -7)   
Hello tgt,
Just wanted to mention that I spoke with a well-known infertility doctor in New York City last year about GG. He was familiar with it and said he could do it for me but in a more effective manner than Gat himself! He said they did it in an inefficient manner.
I was ready to go do it with him but then learned about PAE and wasted a year on that useless procedure. After my consultation in 2 weeks in Detroit I may speak with this doctor again if the Detroit doctor is a bust.
The doctor's name is Dr. Marc Goldstein and you can google him for his number. I can give you his email if your wish. He is very good at answering questions. I hope he hasn't retired yet!

tgt111
New Member


Date Joined Mar 2017
Total Posts : 6
   Posted 3/17/2017 3:30 PM (GMT -7)   
Hello neil, I googled Dr. Goldstein and I may be wrong but his procedure was very expensive. I think it was around 40k when you total everything...hospital charges etc. Maybe that info was wrong but it can't be too far wrong for a NYC doctor. I don't doubt that he's an expert though. Like I was saying in my other post, I'm not desperate yet. My syptoms are a weak stream a qmx of 8, moderate retention. Also I only have to get up once a night on average....depending on my fluid intake before I go to bed of course. My Prostate is about 55grams..That's not too bad comparitively. But im 54 right now and It's only going to get worse....Why do you consider the PAE useless? Im considering it.

Chicago Dave
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Date Joined Apr 2013
Total Posts : 223
   Posted 3/17/2017 5:12 PM (GMT -7)   
Hi Neil!

I'm sorry that the PAE you had didn't work. Folks on the patient.info prostate forum have been reporting generally good results from this. It's done at two hospitals near me (Duke and UNC) and has a good chance of becoming a standard of treatment in the future.

(As for why PAE seems to be advancing in clinical trials and GG is not, it's probably just a matter of dollars. PAE research is supported by the company that makes the special beads. No comparable intellectual property exists on the GG side, so there just isn't a big prime mover to push it through trials. It takes a lot of dough-re-mi to push these treatments through clinical trials. This issue has come up on this board before, but I've never been bothered by it. I don't have very high expectations for the current medical system.)

You say that you are considering a treatment from your Detroit specialist. I'm just a patient not a doctor, and I hesitate giving out advice here, but I'd suggest confirming that the specialist's treatment is bilateral (not just the side with the varicocele) and that any collaterals will be treated. Supposedly, your specialist knows all this and much more since he's read Gat's papers...but if I were you, I'd confirm it anyway. I've never regretted confirming things with my doctor.

BTW I haven't updated on my 2011 GG procedure because my condition has been stable.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/17/2017 5:19 PM (GMT -7)   
I think the procedure is covered by insurance if a varicocele is present which is almost certain with BPH. Frank had mentioned that the cost of his w/o insurance would have been a few thousand so that is quite a gap.
GG takes a long time to work for most men (over a year). Dr. Gat did not want to do mine last year because my prostate was so large he feared I would develop bladder/kidney problems while waiting for it to kick in. So for you I think it is better to do it while you still have time and you are not in an emergency. What bought me time was learning to do CIC but I don't wish to do it the rest of my life. Many men on this forum have been greatly helped by the GG procedure which is the only minimally-invasive cure available.
PAE gets a lot of hype as it is promoted a lot. I personally think it is being oversold as a panacea. I know a lot of men who were not helped by it - including myself. It addresses the problem remotely in that the constrictions occur around the urethra in the transitional zone but PAE reduces blood flow outside the prostate which then reduces the blood supply to some smaller blood vessels within the body of the prostate. My PAE reduced my prostate size from 280 gm to 180 gms over 6 months yet my IPSS score remained at 26. My MRI showed why: PAE killed tissue throughout the prostate in a very spotty pattern so there was little tissue necrosis around the urethra where it is needed.
Further, the statistics are skewed towards success stories. UNC dropped me from the 3 month followups when they heard mine failed to improve my scores. I know other guys like this too. Also the durability is very suspect as new blood vessels open almost immediately and grow to re-supply the prostate. This is seen realtime in the GG procedure where collaterals form as soon as the ISVs are closed.

neil123
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Date Joined May 2016
Total Posts : 35
   Posted 3/17/2017 5:32 PM (GMT -7)   
Hi Chicago Dave - it is great hearing from you!! Last year I spent several weeks reading all the posts on the thread from the start making lots of notes and you were (are ) one of my heroes!! Thanks for the advice about GG - I am very aware of what you write having read all the posts here and the papers that were referenced in them.
The VIR in Detroit is young and very open-minded. I offered to send him the GG papers but he already knew the procedure. When I see him in 2 weeks following my scrotal ultrasound to confirm the varicocele I will focus on all these details and grill him. In one of his emails to me he did seem excited to try it out so I will let you know but thanks for the reminder. Please mention anything else you think I should bring up with him.
I know many men who had temporary relief from their PAEs though some of the glowing reports were due more to the steroids they took for a week afterwards than anything else. Most reverted back after a year or so. I do not trust the statistics presented in the papers. It is an indirect procedure at best in treating BPH and there are many variables, known and unknown that determine its outcome. At least GG tries to address the source of the problem. Your story and others here have inspired me and I wish I hadn't wasted a year on PAE though I did learn CIC during this time which keeps me away from the uro's knife.
Thanks again.

Frank in Florida
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Date Joined Oct 2013
Total Posts : 27
   Posted 3/17/2017 6:20 PM (GMT -7)   
Dave: I think there is another reason we don't see much published research into the GG procedure. I, and others on this forum (I think), have noted that it takes a year or more for the benefits to become apparent (13 months in my case). There was a recent study in Europe of six months duration which showed only mild benefit...I can't find their final report of longer duration, if there is one. PAE shows quick results and it is easy to conduct a study showing its benefit. You would probably need a two-year-long study to prove the benefits of the GG procedure, and that is logistically difficult to perform.

One more thing: Dr. Julien embolized my left ISV without problem, but he looked very hard for the right ISV without success. None of the injected dye was seen to enter the right ISV, probably indicating that the valves were still intact preventing backflow. That makes sense seeing that I got great clinical improvement from the procedure.

By the way, make sure your ultrasound study includes a standing and coughing view of the scrotum to really make the varicocele(s) visible. A post-op ultrasound for me showed no varicocele on either side.

Another by the way: I had lost the temperature reflex in my scrotum, but it returned after the procedure (I hadn't noticed that it was gone). Now, if my scrotum gets cold my testicles withdraw tightly towards my abdomen. I figure that is a sign to follow in case there is a recurrence.

neil123
Regular Member


Date Joined May 2016
Total Posts : 35
   Posted 3/17/2017 6:57 PM (GMT -7)   
Hi Frank -
I do have the paper you refer to here. The title is:
" Treatment of BPH by Occlusion of the Impaired Urogenital Venous System - First Experience", by H. Strunk et al 2014.
It did show good results over a 6 month period and is the only study independent of Gat that I could find.
I wrote Dr. Strunk last year and asked him if he had continued to follow these men but he said he could not get funding to continue the study. I recall he wrote that he had received a lot of funding to conduct a HIFU study.
Thanks for the advice about the scrotal ultrasound.
I guess they don't require color Doppler as Gat/Goren do?
Dr. Julien sounds great and I would have gone with him but I could not get past the lions at the gate to speak with him! He would probably be upset to know that he lost 2 potential customers because of the by-the-book screeners who man the phone.

neil123
Regular Member


Date Joined May 2016
Total Posts : 35
   Posted 3/19/2017 6:35 PM (GMT -7)   
Hi Frank,
I know this is a big favor to ask of you so I will totally understand if you say no.
As you are a patient of Dr. Julien would it be possible for you to let him know that two out-of-state guys are trying to reach him to discuss getting the same procedure you had and if he would provide an email or phone number so we could reach him directly?
I am not overly confident about this doc in Detroit and you already had a good experience with Dr. Julien which is worth a lot to new guys.
Thanks Frank.

Frank in Florida
Regular Member


Date Joined Oct 2013
Total Posts : 27
   Posted 3/20/2017 10:11 AM (GMT -7)   
I've contacted Dr. Julien and let him know there is untapped demand for this procedure, and I gave him the URL for this newsgroup. I don't know if he will pursue it as he already has a busy practice doing other procedures. The first impression I got of his medical office was that it was small...later, for my procedure, they opened the side door from the office and there was a procedure area that looked like 5-6 fully-equipped operating rooms combined! I was impressed. There was a constant flow of patients that day.

Incidentally, the day of my initial exam there was an opening in his schedule the following day to have the procedure done. I'm not sure how often that occurs. I couldn't spend the night and have it done as I needed to go back and get my wife to accompany me. I had mine done the following week.

Good luck!
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