The Value Of Multi-parameter MRI Pi-rads Score Combined With PSAD In Improving The Positive Rate Of Prostate Puncture

Objective To analyze the relationship between prostate multi-parameter MRI pi-rads score and PSAD and the positive rate of prostate puncture,and to investigate the value of PI-RADS score combined with PSAD in the diagnosis of prostate cancer.Methods The clinical data of 351 patients who underwent prostate MRI in the General Hospital of Ningxia Medical University from March 2014 to December 2019 were collected.Patients were divided into two groups based on postoperative pathological results:PCA group（109 cases）and n-PCa group（252 cases）.The age,pi-rads score,TPSA,f/TPSA and PSAD of the two groups were compared,and the value of the above indicators in prostate biopsy was judged by the ROC curve.Multi-parameter MRI pi-rads score and PSAD focus on early diagnosis of PCA.According to the pathological Gleason score,patients in the PCA group were divided into two groups:low-risk group（Gleason score<7）and high-risk group （Gleason score≥7）.Based on the results of pi-rads and PSAD,the positive rate of prostate puncture was calculated.Results（1）.As the patient’s age increases,the positive rate of prostate puncture gradually increases(X²_trend=128.122,P<0.001);as the PSA concentration increases,the positive rate of prostate puncture gradually increases(X²_trend=108.537,P<0.001);as the PI-RADS score increases,the positive rate of prostate puncture gradually increases(X²_trend=107.743,P<0.001).（2）.The age,PI-RADS score,tPSA value,and PSAD value of the PCa group were higher than those of the non-PCa group,and the differences were statistically significant（P<0.05）.The f/tPSA value of the PCa group was less than that of the non-PCa group,and thedifferences were statistically significant（P<0.05）.（3）.Patient age,PI-RADS score,tPSA value,f/tPSA,and PSAD value can all improve the detection rate of PCa.PI-RADS score has the highest testing power,followed by PSAD value.When the PI-RADS score was divided into three thresholds,the Jordan index was the largest with a value of 0.75.The sensitivity,specificity,positive predictive value,and negative predictive value of PCa adenocarcinoma were 82.3%,92.7%,84.3%and 81.1%.When the PSAD value was 0.21 as the threshold,the Jordan index was the largest at 0.458.The sensitivity,specificity,positive predictive value,and negative predictive value of PCa adenocarcinoma were 78.0%,67.8%,68.3%,and 76.6%.（4）.PI-RADS score was positively correlated with Gleason score;tPSA was positively correlated with Gleason score;PSAD was positively correlated with Gleason score;f/tPSA was not correlated with Gleason score.（5）.When the PI-RADS score is less than 3 points and the PSAD value is less than 0.21,the positive rate of prostate cancer puncture is 0%;when the PI-RADS score is more than 3 points and the PSAD value is greater than 0.21,the positive rate of prostate cancer puncture is 82.29%;when When the PI-RADS score=3 points,and the PSAD value was≤0.21 or>0.21,the positive puncture rate was5.56%or 15.48%.Conclusion 1.Age,PI-RADS score,tPSA value,PSAD value,and f/tPSA can all improve the detection rate of PCa.Among them,PI-RADS score has the highest test performance,followed by PSAD value.2.The PI-RADS score,tPSA,PSAD of patients were positively correlated with the Gleason score of pathological results;there was no correlation between f/tPSA and Gleason score.3.When PI-RADS score is less than 3 points and PSAD value is less than 0.21,the positive rate of prostate cancer puncture is 0%,which can effectively avoid unnecessary puncture biopsy.When PI-RADS score is more than 3 points and PSAD value is greater than 0.21,The highest rate of prostate biopsy is 82.29%,which can provide reference for accurate puncture of prostate cancer.