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Gat Goren, PAE, LUTS, Part 8

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Posted 9/8/2017 2:53 AM (GMT -6)
Neil, I don;t know where he is performing the procedure. Last time I heard, it was Cyprus. Yes, I watched my procedure on the monitor and Dr G explained each step.

Thanks for the information on the PSa. I'm watching the numbers and have the prostate doubling app. At present trend is downward. Perhaps I should go for a volume check. Had a biopsy years ago before I had the procedure and all was ok but it was an uncomfy thing. I've heard now that there is a urine test now that detects prostate cancer and will go for that rather than the biopsy.
Posted 9/8/2017 9:49 AM (GMT -6)
Hi Andy,

There is a new urine test for prostate cancer called SelectMDx developed in Belgium. The urine is collected after a standard DRE test. It looks for mRNA associated with aggressive prostate cancers. I just had it and my results were 14% for aggressive cancer and 34% for a blind needle biopsy. That is goo for a 220gm prostate! All that matters for us is clinically significant prostate cancer - not microscopic cells picked up by a random needle biopsy. Here is a link to their site:

http://mdxhealth.com/selectmdx-prostate-cancer

Could you tell me how quickly after your GG procedure 5 years ago you started to notice an improvement in your peeing? Was it a gradual improvement over many months or was it right away after the procedure compared to the night before?

I wonder why new guys who had GG stopped contributing to this site. There were 18 over a period of 3 years that kept coming on board here and then it suddenly stopped about a year ago. Do you think they went over to another site?
All the best
Neil
(p.s. my name at the old Inspire site was "peealot" or as my wife calls me "Sir Peealot" )
Posted 9/8/2017 10:22 AM (GMT -6)
Neil,

I remember you well now. Sir Peealot.....

Thanks for the info and link.

Improvement although very slight, was immediate. However further improvements took 3 - 4 years and I must say, there are times - a few days each - where I think I'm regressing, however, after that period, there appears to be an improvement. So, it's not an overnight cure.
Posted 9/13/2017 2:23 PM (GMT -6)
I underwent GG procedure in Laniado Hospital, Netanya, Israel. It was on June 18th 2017. Procedure was made by dr Goren, (dr Gat was present as well). Both examination before and after was made by dr Gat in his office.
Posted 9/15/2017 4:12 PM (GMT -6)
SIX-YEAR UPDATE
--------------------

It's now been over six full years since I had my GG procedure on 30 May 2011. I'm typically pretty punctual posting updates, but this year I got distracted. Sorry for the 3-month delay, but there was honestly nothing much different that would spur me to write.

Nightly visits to the washroom remain at about one a night. Daytime visits are at least two hours apart but can be as long as six hours if I don't drink anything. My prostate, 51 grams before the procedure, shrunk to under 25 grams a year later. It has maintained that size at least through last Summer, when I last had it measured.

The only change in the past year is a 40%+ increase in my low testosterone levels since late 2015. This increase was confirmed by a repeat measurement, so I believe it to be a real improvement not just a fluke. I don't think the increase was a delayed result of the GG procedure. Rather, I think it was the natural result of losing 30+ pounds. Regardless, it's nice.

I'll update next year, or sooner if there are sudden big changes.

--------------------------------
Neil: I will be in Toronto at the end of this month. Private message me if you want to meet for moral support while I'm in your neck of the woods. I'm sorry that your PAE didn't work--I have read a lot of good reviews about that procedure.
Posted 9/30/2017 11:19 AM (GMT -6)
Just came across this new article on the Gat Goren method (published few days ago)
I suppose this is the study they where working on in the last few years
It includes data on 206 patients and a follow-up of 12-24 months

It shows very high success rates and minor side effects as described here already by all of us. Is any one here can get a hand on the full paper?

"Benign Prostatic Hyperplasia: Long-term follow-up of prostate volume reduction after sclerotherapy of the internal spermatic veins"
Here is a link:
http://onlinelibrary.wiley.com/doi/10.1111/and.12870/abstract
Posted 10/26/2017 5:06 PM (GMT -6)
New to the group so hello to all and thanks for taking the time to share your experiences as they have been very helpful!

I am a 59 year old male in excellence health with the exception of my BPH. I have been on Afuzosin to relax my prostrate and bladder neck muscles for the last two years. My BPH symptoms have recently gotten worse and have begun really impacting my quality of life. My urologist has suggested that I either start taking Finasteride to shrink my prostrate of think about having surgery. I have elected to not have either given the potential side effects of each.

I stumbled upon this group one evening when I could not sleep which then lead me to read all of the GG research papers including his latest that summarized his results over 206 patients. The term veracosele caught my eye as back when I was having my family I was told by fertility specialists that I probably had one. My urologist has since confirmed that by touch. Reading the articles and comparing them to current conventional medical treatment for BPH, it seems to me that the urologists want to treat symptoms while GG wants to treat the root cause of the problems. This resonated with me as my Dr degree in Mechanical Engineering taught me to solve problems.

I called and emailed the GG clinic in Israel this morning, but did not actually speak with anyone. I am anxious to start the process to see if they believe that I am a candidate for the procedure. I would be interested in others that recently engaged with them, what the process was like, what tests they recommended and the approximate timeline of activities up to your trip to have the procedure done.

Thanks again for all of you who have contributed to this forum!
Posted 10/29/2017 4:07 PM (GMT -6)
Hi,

I started to talk with Dr. Gat in February 2017. I hat to complete:

To be able to offer you the treatment we need from you 2 basic tests, 3 medical documents and few answers.
Here they are:

Tests:
1. Abdominal Ultra-Sound for: Kidneys, Liver, Urinary bladder, Prostate volume, Urinary residual volume (usually all 5 of them can be done on one test).
2. Blood test for:
- Complete blood count
- Free Testosterone, PSA
- Serology for: HIV, Hepatitis B+C
- Coagulation factors (PT, PTT, INR)
- Kidney functions (Serum creatinine, Urea)
- Liver functions: GOT, GPT, alkaline phosphate
(In most of the cases all can be done in one sample).
Please copy this list and make sure that the doctor and the lab provide you all this categories.

Documents:
A The last Medical summary report from your doctor - GP (about your medical condition)
B. The last Medical summary report from your urologist
C. Please complete the questionnaire that is attaches to this email

Questions:
1. Do you have any health problems?
2. Any medications that you take in a regular basis (Aspirin included)?
3. Do you have a sensitivity to iodine?
4. Have ever underwent a Hernia operation? If it is inguinal hernia, was it on the right or on left side?
5. Have you ever been offered a TURP treatment?

It took me almost four months to complete all of these tests.
And procedure took place on 18th of June.
Posted 11/2/2017 9:42 PM (GMT -6)
MariusZ

Many thanks for your reply and sending the list of tests as well as the approximate time that it took you to get them done. Subsequent to your reply, I did receive an email back from Dr Gat with the same list about a week after I had called and emailed the clinic. I am now beginning the process of working with my Urologist and GP to have the tests completed. Did your health insurance pay for any of the tests and if so which ones? After you submitted the test results back to the clinic, how long did it take to get your procedure scheduled?

Thanks for your reply in advance!
Posted 11/5/2017 8:54 PM (GMT -6)
Hi Steve,

I sent all results on 6th of April and I got my procedure scheduled on 26th of April (so, it took me two months not four to collect all tests).
And my insurance covered all this tests (AmeriHealth New Jersey).

Good luck with your treatment smile
Posted 1/12/2018 10:16 AM (GMT -6)
Time flies...I haven't visited this forum in a while. I am almost 4 years out from my ISV embolization. As of two weeks ago I was doing very well, basically ignoring my prostate. I have continued on daily Cialis, but mainly because it also helps treat my hypertension. My PSA was cut in half.

Last week I underwent general anesthesia for a ventral hernia repair. After surgery I developed urinary retention and had a foley inserted for a few days. My urologist was very helpful: he just kept chanting TURP, TURP, TURP. I am now switching to a new urologist.

Thanks, someone, for the referral to patient.info. There were several guys there who also had problems after general anesthesia. It sounds like I might have an atonic/flaccid bladder. I've started doing self-catheterization but am now down to bedtime only.

In retrospect, I think I have had bladder problems for a long time, probably dating from my prostate problems before my embolization. I had been having what I called "double voiding", ie I would pee a small amount and then 5 minutes later pee a much larger volume. This certainly sounds like it could be due to bladder muscle weakness.

I have ordered a bunch of catheters to try (I am using a 16FR rubber catheter now which is not very comfortable). When they arrive I will probably try 5x/day catheterization in an attempt to rehab my bladder. I have high hopes that this is a temporary situation, though I will probably continue bedtime catheterizations to reduce the chance of waking up to pee.

So, bottom line, I am very happy that I had the embolization done and consider myself a success story.

To others here, all you need to do is find a radiologist who does varicocele embolization for infertility and talk him into doing the same procedure for you. If the varicocele is uncomfortable, Medicare will pay for it.

Good luck.
Posted 3/4/2018 5:24 AM (GMT -6)

andyaction said...
All - and Neil especially:

As long term contributors to this discussion will know. I had the GG procedure back in 2012.
Then I was 60.

At that time, it took me half an hour to pee and then ten minutes later, I need to go again, I was getting up at least five times every night, going out led me to developing a portable disposable super absorbent bag in case of emergencies and my life was in effect, ruined.

Today, over 5 years since the procedure. I sleep almost every night without needing to go to the loo. I have a steady, medium flow, continuous stream and go just about normally with regards frequency. Whereas it's not 100% - like when I was a teenager, I now live life without worrying. Here's my concern: PSA is 7.5 - last tested 2 months ago. This is down from 9.5 six months previously. I have been taking POMI - T supplement and guys, this appears to be working well. I will psa test again in a few months and keep you all posted.

Neil, if you consider an embolization make sure that it's not just the spermatic veins that are closed off. Ensure the capilliaries that open up are also sealed. Check this with your specialist


Andy, what was your PSA at time of the procedure with Gat Goren? As you may know, GG have published a study re the effect of their treatment on prostate cancer. It was on only 6 men, and all were only Gleason 6. The results were i think 5 out of 6 men were with no prostate cancer found in a biopsy , after only 6 months. That's impressive. Dr. Gat says their is logic behind it because the GG treatment reduced the FT (Free T') inside the prostate, and that reduces the growth of the cancer. In light of the above, I wonder how come your PSA has gone up? This is why I ask what was your PSA prior to the GG treatment? Thanks.
Posted 3/26/2018 3:44 AM (GMT -6)
Hi. It's been a while since I visited and posted.
I had PAE about 5 years ago at a time with the Gat-Goren folks weren't answering emails and when they finally did it was to inform me they had stopped the procedures for a while.

So I found someone in the USA doing PAE.
My prostate measured about 51 or 53.
I was having to self-cath.
I had multiple diverticuli in the bladder.
Small bladder neck.
I had been on flomax for some time.

6 months After PAE, there was minor improvement. underline minor. even though prostate shrank to 31.
I went to Birmingham to get further info and a procedure on either bladder neck or diverticuli.
After talking it over with them, we opted to fix the divertiuli first.
There was more improvement, but not enough to quit meds.

They mentioned doing the bladder neck resection, but myself, my wife, and my local uro did not want to risk the side effects.
So, they added daily Cialis to help the flomax and Proscar.

5 years later, I am still doing OK but not braggable, but I do not regret the PAE because things would be awful if I had not had it done.
My urinary retention is still about 250 ml, though it had improved to about 120 ml for a while.
At 5 years my prostate has not grown any.
I've tried to quit Cialis or Flomax quite a few times at the advice of my uro, but it never works out.
I only take Proscar, though, about every 2-3 days.

I have been using this uro since just before my PAE. I changed to him after the last one was pushing me to do a laser treatment all the while not being honest about the side effects.
My present uro was helpful and supportive as I sought the PAE.

I keep thinking about seeking to have the variocele fixed, but my present uro says that I only have a small one that is insignificant. But 15 years ago I was told that I had bi-lateral with the left side being fairly large. I don't know if it had improved or what happened.

I want to be off the meds, but I sure don't want to risk impotence, full retro, and/or incontinence that comes with bladder neck resection.

I keep biding my time being better than I was, but not where I want to be.
Posted 5/9/2018 4:05 PM (GMT -6)
It's been close to a year and a half since I posted.

I wonder how Neil123 made out. He was scheduled for his procedeure in October, but hasn't posted since September.

Steve-in-Boston stated he was reluctant to take Finasteride because of side effects. I've been taking Dutasteride (stronger than Finasteride I believe) since Nov., 2015 and have had no side effects, except my PSA went from 8.7 to 1.2. I wish I had started taking it 5 years ago. It might have saved me some pain and suffering, though my urologist was reluctant to suggest it until I brought it up and tried to discourage me from taking it, offering Finasteride instead. But my research indicated Dutasteride has had superior results to Finasteride.

For those not familiar with my story, I was interested in PAE and GG, after having had not great results with the Greenlight laser in June 2012 on a 128g. prostate. But two emergency procedures over the next 3 years precluded my having a choice in the matter. In Dec. 2013 I had spontaneous bleeding of frank blood from the prostate and had an emergency second greenlight laser to cauterize several bleeding spots, resection part of the bladder mouth, and remove bladder stones. In April 2015 I had another spontaneous prostate bleed of clotting blood that sent me to the hospital. On my first bleed I needed 8 pints of whole blood. On the second bleed I needed 6 pints. This time a GL machine wasn't available (lucky for me) so my uro did a classic turp. My prostate had grown to 313g. before the turp, but was measured at 195g. afterward. The turp also had the benefit of providing tissue for a biopsy, which showed no cancer.

Six months later my prostate was up to 205 g. and I started taking the dutasteride (0.6mg. daily) and still do. However I had no problems urinating and my PVR (post void residual) was only 32ml. After a year on dutasteride my prostate was measured at 235g. but I still had no trouble urinating and my PVR was still 32ml. I've been on dutasteride almost 2-1/2 years now and still have no trouble urinating, but I haven't gone back for an ultrasound or PVR check. I figure at this point I'll wait for symptoms.

Regarding all three procedures, they solved my retention problem, and the last procedure solved my PVR problem (my PVR was 400ml prior to the first GL and 125-200ml after) but never fixed my urinating at night. I still get up 3 times a night on average, and pee in a bedside urinal I keep in a basket by the bed, in the dark, and get right back to sleep.

An interesting fact I learned is it's not the size of the prostate but the path from the bladder to the urethra that causes the retention. If the passage is large enough, it seems it doesn't matter how large the prostate is.

I also had a fairly large median lobe (my uro claimed he reduced it somewhat during the turp) but as long as it doesn't block the bladder mouth, all it does is decrease your bladder capacity. Around 6 months after my first GL some scar tissue grew across my external sphincter (between the prostatic urethra and the urethra) which was removed with a systoscope tool. However I had to cath once a month for a year to keep the channel open. While cathing I could tell the median lobe protrusion was about an inch inside my bladder mouth, so it didn't block the blsdder mouth. An ultrasound showed the median lobe took up about 15% the volume of the bladder after the second GL.

While I would never recommend the Greenlight laser, I seemed to have good results to date (almost 3 years) with the classic turp. Whether it was the turp, or the fact that this was the third procedure in just 3 years, I don't know. The turp did give me retro, but it didn't effect my sex life. Orgasms are dry as the sperm goes into the bladder, but just as enjoyable as they always were.

I don't know if my experience will be of any use to those here, but I'm somewhat of an abnormality. My uro said I had the largest prostate he had ever seen. What I did find out was that most of what I had read about, hoped for or feared in dealing with my prostate turned out to be different than what I expected.

Post Edited (Bob_NJ) : 5/10/2018 12:35:31 PM (GMT-6)

Posted 5/27/2018 10:52 AM (GMT -6)
SEVEN-YEAR UPDATE
-----------------------

It's now been seven years since my Gat-Goren procedure on 30 May 2011. Nothing much has changed, for the better or worse, since my last update a year ago. Frequency and urgency have remained the same, but of course are dramatically improved since before the procedure. I still get up to pee once a night typically. My testosterone, though still at a low level for most men, has maintained its rise I first noticed late last year. I attribute this improvement mostly to weight loss though.

Next update in a year, or sooner if something dramatic changes.
Posted 11/11/2018 11:48 AM (GMT -6)
Hello All. New joiner here.

I am considering travelling to Tel Aviv for the Gat Goren procedure to treat my BPH. This thread (well, all 8 threads!) have been a mine of information - thanks so much to everyone for these superb insights.

I have got as far as speaking with Dr Gat and gathering the various tests he asks for. The final hurdle was seeing the Urologist a few days ago, who was extremely sceptical, to put it mildly. I think I have my eyes open, and understand the scientific scepticism (my background is in biological sciences and engineering), but the Gat Goren notion does for me pass the "smell test" (smells and sounds plausible and right - I do know that is not scientific by the way!). There seems to be an element of "not invented here" with the Urologists - it would be tough to admit that they might have missed something rather simple in the aetiology of BPH and PCa.

This thread has been quiet for the past few months, so I'm just checking in to ask if anyone has any new insights or post-GG updates to relate. If not that's fine... there is plenty for me to digest. I'll post again after the procedure, if I go.

@andyaction - just wondering if you are still around here. I'd be interested in getting in touch as we are both in Essex (well some of the time anyway for me - Brighton the rest of the time). I think there is no facility for private messaging on this board; please correct me if I've missed it.

Thanks again,
Roger.
Posted 1/10/2019 11:14 AM (GMT -6)
Hello Everyone. Happy and healthy new year.

My GG procedure was undertaken in March 2012. Life is ok now with no issues that cause me concern. I take no medications and go normally. Normal frequency and just about no night time visits unless I drink late- I'm now 67 so, I'm not worried about that odd visit at night.

I did try to get life insurance with aviva but they declined me as I'd had the GG procedure and a prostate problem
and had asked a year or so ago, for a follow up with my urologist a chap called RAVI - I call him Mr Sceptical - who was just not interested at the time - this follow up was really to give info back to GG.

Rogw, I'm in Upminster. Get your phone number to me somehow and I'll call you. I don;t know how to provide details on this site - a PCA site I mentioned GG on, resulted in death threats from a nutcase who felt should not have mentioned this procedure! Crazy.

Neil - prior to GG 5.7. I'm going again to get my psa tested and will keep you all posted.
Posted 1/11/2019 3:28 AM (GMT -6)
Andy,

Good to hear that all is well and thanks for the reply.

I'd really appreciate a chat on the phone as soon as is convenient. Reluctant to post a phone number on here but could you email me please on roger77 [at] gmail [dot] com (making the usual substitutions)?

Best wishes to all. Happy New Year!
Roger.
Posted 1/11/2019 4:36 AM (GMT -6)
Ah just noticed that I have "show email address" ON in my profile so Andy it should be possible to see it there also.

Thanks,
Roger.
Posted 10/29/2019 8:00 PM (GMT -6)
Not a very active thread.... :-(

Eight-year update of my GG procedure. No noticeable changes since last year. I'm still getting up once a night, and still experience some frequency in the day. Despite this, it's still an enormous improvement from before the procedure.

Signing out for now...I'll update as needed.
Posted 10/31/2019 2:55 PM (GMT -6)
Dave - thanks for the report. It encourages me to write also.

I had the GG procedure in January this year (2019), and the results have been positive.

Now, 9 months later, my urinary flow is better, though not back to how it was when I was younger. Quite tolerable though, and I now only rarely experience that worrying "few drops" peeing that occurred frequently before the procedure.

My prostate volume is down from 60 to 51ml on MRI, though the radiologist says this is well within their margin of error and therefore not significant. He has a point. Reported volume varied from 90 to 60ml on MRI and ultrasound before the procedure depending on machine and operator. The 60 and 51ml were from the same MRI machine, same radiologist.

Roger.
Posted 12/18/2019 9:50 AM (GMT -6)
Thank you Chicago Dave for your regular posts and the several others who shared their stories. It is in some ways a pity there is not more regular data on the Gat Goren procedure as it makes sense and there is little adverse comment about it. One hopes that it is not lost to humanity....

Could I email you rogw as I am considering the procedure (having followed this thread for several years but believed the procedure had stopped as others reported no response from the clinic a while back).
Posted 12/18/2019 10:44 AM (GMT -6)
Hello Walkjim.

Yes please do: email in my profile is public.
(maybe you just have smile )

Best wishes,
Roger.

Post Edited (rogw) : 12/19/2019 5:44:13 AM (GMT-7)

Posted 3/29/2020 11:54 AM (GMT -6)
Six year f/u. I had my ISV's embolized in March, 2014, in South Florida. My varicocele resolved in one month but my bph symptoms did not improve for 13 months. I went off my bph meds and had no trouble pee'ing. I also have interstitial cystitis and that is controlled with diet. Two years ago I had a foley catheter inserted during surgery and subsequently developed urinary retention and prostatitis. I have been using intermittent catheterization since then. The prostatitis finally resolved after about 18 months (it was sterile). My current obstruction is very sensitive to spicy foods, food additives, and certain medications (chlorthalidone and antihistamines are the worst). When I avoid the offending drugs and foods I can get my post-void residual down to 20 ml--i.e. no obstruction. I am disappointed that this method has not caught on more. I am very happy with the results. I want to reiterate that the GG method is basically the same method that has been used for many years for treating varicoceles. My varicocele was symptomatic so Medicare paid for the procedure. If you talk to any interventional radiologist (at least in the U.S.) they can perform the procedure for a fraction of what GG charges.
Posted 4/1/2020 7:26 AM (GMT -6)
Frank,
Thanks very much for posting your follow-up.

Here 15 months after my Israel trip my peeing is much better and (as mentioned before) my prostate was objectively smaller after 6 months (though "not significantly" according to my dear dismissive docs). Very happy subjectively.

Yes it's well worth reiterating, as you say, that this procedure is nothing very special from the surgical point of view, just the standard varicocele ISV embolization but on both sides, not just the side of the overt varicocele. Straightforward and relatively cheap.

Here in the UK docs tend to be reticent about doing anything which is not the standard treatment, which of course this isn't for BPH, even privately (i.e. outside of the NHS). My private Urologist wasn't interested in referring me. Nevertheless it might be possible to find a maverick Interventional Radiologist here - I haven't done an extensive survey!

Best wishes,
Roger.
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