How to Build a Prostatic Artery Embolization (PAE) Practice

[Michael Barraza]
Now, Ari, when I was a fellow, when we had these patients, we would do most of the pre-procedure workup and the follow-up, but I was really impressed with this system that you all developed at UNC. This collaborative partnership with urology, it's both innovative and it seemed to be ideal for both patients, and physicians.

Could you share with us how that works, how it got started, and how you guys as a team managed the patient before and after the procedure?

[Ari Isaacson]
Yeah, absolutely. From the very beginning, I didn't want my interest in PAE to be a threat to urology, I wanted to try to approach it in a collaborative way, and get them on board, so they could see the benefit of it for them in the long run. From the very beginning, when I started the clinical trial, I asked one of the urologists to be my co-investigator. I had every patient who we enrolled in the trial, see urology for about four or five visits, associated with the trial, including a cystoscopy. They're getting a good volume of business from this trial.

That made it a legitimate treatment in their eyes, and they got to see firsthand the results of it. When patients did better, they were coming in and seeing urologists ... It's hard to be skeptical when you're seeing the patients yourself.

Then, I was able to present all the data, and the background on the procedure, at Urology Grand Rounds, at UNC. That helped spread it as well. Since then, they've become believers, in the sense that they've seen the data, they've seen the patients, so they understand the value of it, and have started sending patients my way.

[Michael Barraza]
I also thought you made an interesting point that this allows urologists to retain patients, who otherwise might have been lost to follow-up, so they really get to keep their patient population.

[Michael Barraza]
Now, Sonny, is there a typical type of patient that you see pretty frequently? The ones that get referred to you for this procedure.

[Sandeep Bagla]
Yeah. The ones that typically get referred, are the ones, like Ari mentioned, that we go out and promote to be their urologist, or primary care doctors, that we should be seeing. Those are the patients, like Ari mentioned, who had a recent MI, they're on Plavix, for example, they're not gonna get a transurethral procedure for that reason. The patients have a very large prostate, or have some contraindication to surgery general anesthesia, et cetera. Those are the types of patients, who I think are very typical from the referred patients. The patients that other doctors are seeing, and say, "Hey this would be great for PAE.", because their traditional transurethral surgery may not be ideal for them.

The other patient population that comes to interventionalists, and I think as the procedure becomes more widely recognized, will be directly referred patients. Those patients who come direct to interventionalists ... They're a different patient population, because they themselves are seeking out an alternative option, which is very different from someone, of course, who comes by way of their physician. That type of patient population, is someone who's much more inquisitive, asks numerous questions, would love to have comparative data, and/or a good understanding at how PAE compares to former typical procedures. They're a much more inquisitive bunch. How to handle these two different patient populations is an important skill to learn.