Predictability and Inducibility of Detachment of Prostatic Central Gland Tissue after Prostatic Artery Embolization: Post Hoc Analysis of a Randomized Controlled Trial

J Vasc Interv Radiol. 2019 Feb;30(2):217-224. doi: 10.1016/j.jvir.2018.09.029. Epub 2019 Jan 17.

Abstract

Purpose: To assess the frequency and potential predictors of prostatic central gland tissue detachment (CGD), an enucleation-like reaction that sporadically occurred in a randomized controlled trial assessing efficacy and safety of prostatic artery embolization (PAE).

Materials and methods: Trial data were analyzed to identify patients with CGD after PAE. Clinical parameters, MR imaging findings, technical details of PAE, and periinterventional data were compared between patients with and without CGD to identify parameters for prediction, induction, or early detection of CGD after PAE.

Results: CGD occurred after PAE in 3 of 48 patients (6.3%); these cases had good functional outcomes, but CGD was associated with increased risk of ejaculatory dysfunction and occurrence of complications. Frequency of preoperative transurethral bladder catheterization (100% vs 13.3%; P = .005), central gland index (mean ± standard deviation, 0.86 ± 0.02 vs 0.69 ± 0.14; P < .001), amount of particles applied (1.93 mL ± 0.12 vs 0.96 mL ± 0.36; P < .001), maximum early postoperative pain score (7.33 ± 2.08 vs 1.89 ± 2.40; P = .009), and blood C-reactive protein (CRP) levels after 48 hours (69.0 vs 18.58 mg/dL; P = .045) and 1 week (113.50 vs 5.16 mg/dL; P = .004) were significantly higher in cases of CGD.

Conclusions: CGD is a rare reaction that might be triggered by prostatic zonal anatomy, embolization technique, and mechanical or inflammatory processes. It should be considered in patients with severe postoperative pain and high CRP levels who experience voiding dysfunction after PAE to avoid complications. Investigation of larger cohorts might further elucidate this tissue response.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arteries*
  • Biomarkers / blood
  • Biopsy
  • C-Reactive Protein / metabolism
  • Cystoscopy
  • Embolization, Therapeutic / adverse effects*
  • Embolization, Therapeutic / methods
  • Humans
  • Inflammation Mediators / blood
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Necrosis
  • Pain, Postoperative / etiology
  • Prostate / blood supply*
  • Prostate / pathology*
  • Prostatic Hyperplasia / pathology
  • Prostatic Hyperplasia / therapy*
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Urination Disorders / etiology

Substances

  • Biomarkers
  • Inflammation Mediators
  • C-Reactive Protein