| Background:Prostate cancer(prostate cancer PCa)is one of the most common malignant tumors of middle-aged and elderly men,and its morbidity and mortality have been increasing in recent years.The incidence and mortality of prostate cancer in China are lower than the world level,but in recent years,with the economic development,the changes in people’s lifestyles and the increase in environmental pollution in the surrounding areas,the incidence of prostate cancer and mortality have increased rapidly in regions with rapid economic development,Seriously endangering the health of middle-aged and elderly men.The determination of serum prostate specific antigen(PSA),color Doppler ultrasound and magnetic resonance imaging are the main methods of diagnosing prostate cancer,and the diagnosis depends on prostate biopsy.The impact of the percentage of cancerous tumor tissue in prostate biopsy specimens on the prognosis of prostate cancer patients and the significance of clinical practice guidance are rarely reported at home and abroad,and further research is needed.Objective:1.Analyze the detection rate and complications of prostate cancer through perineal prostate biopsy by rectal ultrasound localization in our hospital;2.Explore and analyze the clinical significance of cancer tissue percentage in prostate biopsy specimens.Methods:A total of 711 patients underwent perineal prostate biopsy under the guidance of rectal ultrasound guided by Henan Provincial People’s Hospital from January 2015 to October 2018 were collected.The clinical and pathological data of the patients were collected,including: age(years),Serum prostate specific antigen(ng / ml),prostate volume(ml),prostate specific antigen density(PSAD)and the number of puncture-positive needles,length of puncture tissue per needle(cm),percentage of cancer tissue(%),Gleason score(GS)etc.Using SPSS22.0 statistical analysis software,using t test,chi-square test and other statistical methods,retrospectively analyze and evaluate the detection rate and safety of prostate cancer through perineal prostate biopsy;analyze the serum PSA level and clinical staging of patients before puncture,To explore the correlation between serum PSA,clinical stage and the percentage of prostate cancer tissue;based on the specific relationship between biopsy and postoperative pathology after radical surgery,it was further defined as the corresponding degraded/consistent/upgraded group(A/B/C),and analyze A + B Is there any difference in the distribution of biopsy and postoperative Gleason score between the B + C group? However,by comparing the differences between group B and group C in terms of specific age,PV index,Gleason score,percentage of positive puncture needles,and percentage of cancer tissue per needle,we were able to explore the corresponding statistical value,so as to explore various factors affecting postoperative pathological upgrade.By referring to the corresponding multi-factor analysis method and based on the systematic analysis of multiple dimensions,the relevant independent risk factors for pathological escalation can be obtained.Results:The positive rate of prostate biopsy for PSA at less than 4ng / ml,4 to 10 ng / ml,10 to 20 ng / ml,20 to 50 ng / ml,50 to 100 ng / ml,and more than 100 ng / ml was 23.53%,25.81%,45.14%,55.91%,63.16% and 76.75%,the overall positive rate was 57.0%.The number of punctures with PSA> 100 ng / ml accounted for 38.1%(271/711).The rectal color Doppler ultrasound positioning free hand perineal prostate puncture biopsy was accurate and effective.It was concluded that the final consistent parameter of prostate puncture and postoperative radical resection was about 60.9%,postoperative pathological escalation cases accounted for about 34.6%,and postoperative pathology decayed cases accounted for about 4.5%.There was no statistically significant difference in the distribution of puncture pathology and postoperative pathology Gleason score between the consistent group and the degraded group(P = 0.45> 0.05);while the difference in the distribution of GS between the upgraded group and the consistent group was statistically significant(P = 0.015 <0.05).Based on single-factor and multi-factor studies in multiple dimensions,it can be concluded that volume,puncture positive rate,para-carcinoma rate and puncture GS are independent factors for upgrading.In this study,405 patients with prostate cancer were divided into three groups of <30 ml,30-60 ml,and> 60 ml according to the size of the prostate.The correlation between the PSA value and the proportion of cancer tissue in the puncture tissue was analyzed by group.Calculate the sample correlation coefficient r,and the r values are all greater than 0,indicating that there is a positive linear correlation between the PSA value and the proportion of cancer tissue in the puncture tissue.The greater the possibility of organizational proportion.The average percentage of cancer tissue per needle is related to clinical stage,and the correlation coefficient r = 0.345.An average of more than 36.73% of cancer tissue per needle indicates that it has entered a local stage of progression;more than 56.21% indicates that metastasis may occur.Conclusions:Rectal ultrasound positioning free hand transperineal prostate biopsy is safe and effective.The PSA value of puncture patients in our hospital is high,and the proportion of cases with Gleason score greater than 7 is high.The ideal consistency of GS score after biopsy and surgery was not achieved,especially after radical surgery,there were relatively more upgrades.In this analysis,age,PSA before puncture,PSAD,time interval between puncture and operation,and clinical stage were not associated with the occurrence of escalation.Gleason,number of positive needles,proportion of needle cancer tissue and small volume were found to be the risk factors for escalation.By building a new Nomogram model,the subsequent scientific prediction of the existing upgrade risk can be carried out so as to more accurately and scientifically guide the postoperative clinical medical activities.There was a positive linear correlation between the PSA value and clinical stage before puncture and the percentage of cancer tissue in the puncture tissue. |
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