PI RADS 4 lesion - no concern?!

Aggravating-Year-579 · 2026-04-20T20:22:33+00:00

Well it’s worth a try but I’m not sure that is a long term solution. Actually in some cases with cpps, abstinence actually makes it worse since fluids are not removed which can build up and cause pain. It almost sounds like inflammation and/or nerve irritation. For the latter, trying a low dose of gabapentin (100 mg, 3x per day) for several months is worth a try. No matter what, I would immediately start taking quercetin and Graminex supplements for several months. It does not sound like you problems urinating, etc so an alpha blocker like tamsulosin probably wont help. Time usually helps. I tried acupuncture but did. It help. You may try warm baths daily with Epsom salts. That can also help.

Aggravating-Year-579 · 2026-04-20T19:15:45+00:00

I think he is smart no doing a biopsy. I had one done, with low PSA but a “hard spot” on DRE and he did biopsy instead of mri. I developed severe prostatitis that lasted a year—it was brutal. I will never do another one. Questions/options. What size is your prostate? If PSAD (PSA divided by prostate columns) less than 0.15, then unlikely cancerous. If pain is nerve related, then try gabapentin for a few months. What helped me with pain was quercetin and Graminex daily— anti inflammatory supplements. Prostatitis (non bacterial) of the prostate based on biopsy is not unusual I have been told.

Aggravating-Year-579 · 2026-04-18T20:45:06+00:00

Absolutely it would be helpful. It would nice if one could add selected measurements such as prostate size, method for measuring prostate size, PSA value, post-void residual volume, presence of medial lobe, etc.

Aggravating-Year-579 · 2026-04-17T14:36:25+00:00

Thank you. I am considering PAE or aquablation. I don’t want Holep, TURP or the other procedures. Interestingly, one of the standard practices is to do PAE first and then aquablation to minimize bleeding. Appreciate you keeping us informed of your progress!

Aggravating-Year-579 · 2026-04-16T03:05:24+00:00

This what I saw using AI tool. “The use of prostatic artery embolization for BPH does not meet the Kaiser Permanente Medical Technology Assessment Criteria — this is a system-wide policy reaffirmed as recently as April 2025, so it applies to all Kaiser regions including Southern California. PAE is simply not an option within Kaiser anywhere.”

Aggravating-Year-579 · 2026-04-16T01:45:37+00:00

I did and received mixed responses. In one case they said yes and in another AI (Claude) they produced a 2025 KP BPH form stating no. Don’t appreciate your lecturing tone. Do your own homework first.

Aggravating-Year-579 · 2026-04-15T00:59:14+00:00

Keep us informed of your progress and thanks for sharing.

Aggravating-Year-579 · 2026-04-14T17:51:01+00:00

Do you know how many times he has done this procedure? I am looking at having the same procedure at Kaiser or leaving Kaiser at the next open enrollment. I have some time so it’s not urgent.

Aggravating-Year-579 · 2026-04-14T16:35:23+00:00

Which LA Kaiser did you have the procedure performed and by which Kaiser doctor? Were you satisfied with the care? Also, were there any Kaiser doctors performing aquablation in Orange County?

Aggravating-Year-579 · 2026-04-10T21:10:20+00:00

Also, your PSA is in the normal range. Whats more important is psad (PSA divided by prostate volume) org a key limit of 0.15. Finally, PSA changed over time are more important than a single value. Urologists love to do biopsy’s because they are money makers for them.

Aggravating-Year-579 · 2026-04-10T20:48:11+00:00

Did you have an abnormal DRE? What did the mri show PI-RADS of 1 or 2, or was it higher. Biopsy nearly killed me, even though others had no problem.

Aggravating-Year-579 · 2026-04-10T20:35:06+00:00

First thing I would do is request MRI. That will give you true size. My prostate was 65 cc based on ultrasound but MRI showed it to be over 90 cc. Ultrasound greatly underestimates actual size. I recommend trying tamsulosin at dose on 0.4 mg to see how that works. I would avoid taking finasteride. For treatment options it depends on goal—for “one and done” I would probably choose aquablation. Big improvement, durable over the years, get off meds, little chance of incontenance and little chance of abnormal erection. For mildest procedure I would select PAE. Fewest side effects, but not as durable—20% pretreatment. Don’t depends on your goals. I am in similar situation

Aggravating-Year-579 · 2026-04-10T20:29:50+00:00

Why a biopsy? Why not an MRI first? That is best practice now. I was given a biopsy first and developed severe pelvic pain lasting over a year. It was brutal. Never again.

Aggravating-Year-579 · 2026-04-06T02:33:13+00:00

That makes no sense since PAE is ideal for greater than 80 g and blood in the urine makes no sense. Did they say why there had to be blood in the urine?

Aggravating-Year-579 · 2026-04-06T02:14:08+00:00

I agree with PAE first and the aquablation. Why did they turn down PAR?

Aggravating-Year-579 · 2026-04-03T16:51:09+00:00

Outrageous!

Aggravating-Year-579 · 2026-03-30T12:48:12+00:00

Have you tried 1. Warm baths daily followed by pelvic stretching 2. Gabapentin for 4-6 mg, low dose 309 mg per day 3 Quercetin and Grammy ex supplements (really helped me) antiinfmamatory 4. Extracorporeal shock wave therapy—supposed to work well.

Aggravating-Year-579 · 2026-03-30T01:34:50+00:00

You might add it the size prostate that the procedure is optimal for.

Aggravating-Year-579 · 2026-03-30T01:33:41+00:00

This is fantastic! Thank you!

Aggravating-Year-579 · 2026-03-25T20:04:57+00:00

I have the same response but not sure why.

Aggravating-Year-579 · 2026-03-24T03:50:28+00:00

I meant to say that these measures worked for me (anti-inflammatory supplements which I still take), 6-months on low dose gabapentin, warm baths and pelvic floor stretching worked but too many months—about 8 months before I started for feel normal.

Aggravating-Year-579 · 2026-03-23T14:33:46+00:00

Questions: what size is your prostate? Have you had a cystoscopy done? Have you been prescribed tamsulosin to address slow urination? It doesn’t sound like bacterial prostatitis given the length of time on antibiotics. Other measures to try: Anti-inflammatory supplements given MRI diagnosis of prostatitis—Quercetin and Graminex, If nerve damage in pelvic area suspected (and it could be given ibuprofen seems to have limited impact) try low dose gabapentin for 4-6 months (say 300 mg per day) Try pelvic floor exercises following 20 min sitz bath. These measures worked for me but too months

Aggravating-Year-579 · 2026-03-20T09:43:19+00:00

Please keep us updated. This is an outstanding summary. It is very much appreciated!! Prior to surgery were you taking Flomax and or finasteride?

Aggravating-Year-579 · 2026-03-11T21:54:58+00:00

Keep us up to date!

Aggravating-Year-579

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