| Background:As one of the most common malignant tumors in male urology,prostate cancer has seriously affected the health and quality of life of men.In some western developed countries,prostate cancer has surpassed lung cancer and became the first malignant tumor threatening the life and health of elderly men.With the development of Chinese economy and society,the aging of Chinese population is deepening day by day,the changes of people’s life style and diet structure,the gradual enhancement of people’s health awareness and the gradual improvement of medical technology,the incidence of prostate cancer in China is on the rise.Therefore,early diagnosis of PCa plays an important role in the treatment and prognosis of patients.Transrectal ultrasound-guided prostate biopsy has the advantages of less trauma and high positive rate of biopsy,so it has became the gold standard for the diagnosis of prostate cancer.Serum PSA level is one of the important reference indicators to consider whether to perform prostate biopsy,but clinical studies show that prostate cancer is diagnosed by biopsy,at the same time,it also causes a certain number of unnecessary biopsy and missed diagnosis of a small number of positive patients.Therefore,the analysis of the positive rate of prostate biopsy and the results of Glesaon score in different serum PSA levels can improve the positive rate of prostate biopsy and reduce leakage and misbiopsy at the same time.Objectives:The positive rate of prostate biopsy and Gleason score of different PSA levels were compared,and the relationship between PSA and prostate biopsy positive rate and Gleason score was analyzed.Materials and Methods:The clinical data of 534 patients who underwent prostate biopsy in the first affiliated Hospital of Guangzhou Medical University from May 2014 to May 2019 were analyzed retrospectively,such as PSA,fPSA,BMI,etc.According to the level of PSA,they were divided into group A(PSA<4ng/ml),group B(4ng/ml≤PSA<10ng/ml),group C(10ng/ml≤PSA<20ng/ml),group D(PSA≥20ng/ml),and the biopsy results were recorded and analyzed.Comparing the positive rate of prostate biopsy and Gleason score among the four groups.The patients were divided into groups according to the imaging results,and the relationship between B-ultrasound,MRI and puncture results was analyzed.Patients with PSA between 4-10ng/ml were divided into two groups according to whether the puncture result was prostate cancer.The differences of clinical data between the two groups were compared,and the risk factors of prostate cancer when PSA was 4-10ng/ml were analyzed.Results:The age of patients in this study was 71.09±8.93.The age of patients with positive puncture results was 74.17±8.36years,and that of patients with negat ive puncture results was 68.84±8.66.There was significant difference between the t wo groups(p<0.05).The BMI of patients with positive puncture results was 23.17±3.08kg/m~2,and BMI of patients with negative puncture results was 22.95±2.78kg/m~2,and there was no significant difference between the two groups.The tPSA of pati ents with positive puncture and negative puncture were 44.20±72.28,33.13±50.11 n g/ml,respectively,and the f/tPSA of patients with positive puncture and negative p uncture were 0.15±0.10,0.17±0.17,respectively,and there was no significant differe nce between the two groups(p<0.05).The PSAD of patients with positive punctur e and negative puncture were 0.31±0.27,0.25±0.22[ng/(ml·cm~3)],respectively,and there was significant difference between the two groups(p<0.05).The positive rate of puncture was 37.9%(11/29)in group A,44.0%(55/125)in group B,37.9%(55/145)in group C,55.7%(131/235)in group D.Chi-square test showed that there was significant difference between group B and group D(X2=4.507,p=0.011),group C and group D(X2=11.387,p=0.001).There were 11 patients with prostate cance r in group A,3 patients with Gleason score≥8 in group A,55 patients with prosta te cancer in group B,23 patients with Gleason score≥8 in group B,55 patients wi th prostate cancer in group C,29 patients with Gleason score≥8 in group C and86patients with Gleason score≥8 in group D.Chi-square test showed that there was s ignificant difference between group A and group D(X2=6.389,p=0.011),groupB a nd group D(X2=9.068,p=0.003).The 534 patients included in the study were divi ded according to the imaging results.Prostate ultrasound positive patients accounted for 44.6%(238/534)and negative patients accounted for 55.4%(296/534).The pu ncture positive rates were 48.3%(115/238)and 46.3%(137/296),respectively.Ther e was no significant difference in the detection rate of prostate cancer between the two groups(p>0.05).The positive rate of prostate MRI was 45.1%(241/534),and the negative rate was 54.9%(293/534).The positive rate of puncture was 52.3%(126/241)and 43.0%(126/293),respectively.There was significant difference in the d etection rate of prostate cancer between the two groups(p<0.05).Among the 252 pat ients with prostate cancer diagnosed by puncture,66 patients had Gleason score≥8(57.4%),B ultra-negative patients Gleason score≥8 in 71 patients(51.8%).There was no significant difference between the two groups(p>0.05);MRI positive patients Gl eason score≥8 in 72 cases(57.1%),MRI negative patients Gleason score≥8 in 64 ca ses(50.8%),there was no significant difference between the two groups(p>0.05).O f the 125 patients with PSA in the range of 4-10 ng/ml,55 patients(44.0%)had prostate cancer,and the remaining 70 patients(56.0%)had non-prostate cancer.Th ere were significant differences in age,BMI,f/tPSA,PSAD and MRI positive rate between prostate cancer group and non-prostate cancer group.There was no signifi cant difference in the positive rates of tPSA and B-ultrasound between prostate can cer group and non-prostate cancer group(p>0.05).Multiple logistic regression analys is showed that age(OR=1.109;95%CI=1.052-1.170),BMI≥23(OR=2.391;95%CI=1.024-5.580),f/tPSA≤0.16(OR=2.682;95%CI=1.089-6.604),PSAD≥0.15(OR=2.479;95%CI=1.063-5.780)and MRI positive rate(OR=3.654;95%CI=1.527-8.742)were in dependent risk factors for positive prostate biopsy.Conclusions:1.There was a positive correlation between serum PSA level and prostate puncture positive rate and Gleason score.With the increase of serum PSA level,prostate puncture positive rate and Gleason score also increased.2.Positive MRI rate can increase the positive rate of prostate puncture,but there is no significant correlation between ultrasound and puncture results.3.When PSA is in 4-10ng/ml,age,BMI,f/tPSA,PSAD and MRI positive rate are independent risk factors for prostate cancer.4.According to the level of PSA,combined with various auxiliary examination indicators and risk factors,the positive rate of prostate biopsy can be increased to a certain extent,and unnecessary biopsy can be reduced. |
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