Influencing Factors Of Gleason Score Difference Of The Prostate Biopsy And Radical Prostatectomy

Objective: To compare the differences of the Gleason score between the prostate biopsy and radical prostatectomy and analyze the cause of these differences and the related factors that predicted the difference.Methods: Retrieved clinical data of 61 patients with prostate cancer who underwent transrectal prostate biopsy and radical prostatectomy in the First Affiliated Hospital of Guangxi Medical University from June 2012 to November2019,including age,body mass index(BMI),preoperative serum total prostate specific antigen(tPSA),preoperative serum free prostate specific antigen(fPSA),preoperative fPSA / tPSA,prostate volume,prostate specific antigen density(PSAD),number of positive biopsy cores,the total number of biopsy cores,intervals between prostate biopsy and radical prostatectomy,Gleason score of specimens,prostate cancer risk factor grade,positive surgical margin,seminal vesicle invasion,vascular cancer embolus and peripheral nerve invasion,clinical staging,etc.The causes of Gleason score differences and the relationship with clinical data were analyzed retrospectively,and logistic regression analysis was used to perform statistical calculations to understand the relevant clinical indicators affecting postoperative score differences.Results: In all 61 patients,the Gleason score of the biopsy was consistent with the Gleason score after radical prostatectomy in 42 cases(68.85%),and 19 cases were different(31.15%),among which 8 cases had a decrease in the score(13.15%)and 11 cases had an increase in the score(18%).The t-test,chi-square test,and rank sum test were performed according to the type of data variables.The results suggest that the patient’s age,BMI,preoperative tPSA,preoperative fPSA,and number of positive cores,number of biopsy cores,intervals between biopsy and radical prostatectomy,prostate cancer risk factor grade,Gleason score of specimens,positive surgical margin,seminal vesicle invasion,vascular cancer embolus,and peripheral nerve invasion,clinical staging were not statistically significant differences between the two groups(P>0.05).Nevertheless,the preoperative fPSA / tPSA,prostate volume,andPSAD were statistically different between the two groups(P<0.05).Further univariate logistic regression analysis was performed on the above clinical indicators,and the results showed that the preoperative fPSA / tPSA,prostate volume,andPSAD were all influential factors for the difference in Gleason scores after radical prostatectomy(P<0.05),and there were no significant differences in the other results.Multivariate logistic regression analysis was performed on the three statistically significant indicators in the univariate logistic analysis.The results indicated that prostate volume was an independent predictor of the difference in Gleason score after radical prostatectomy(P<0.05).ROC curve analysis of prostate volume found that the area under the curve(AUC)was0.716>0.5,P=0.007,95% CI: 0.579 ～ 0.852.This suggested that the prostate volume had high diagnostic accuracy.By calculating the Yoden index,the best diagnostic cutoff value was 0.78,the corresponding sensitivity was 73.7%,and the specificity was 66.7%.Conclusion: The preoperative fPSA / tPSA,prostate volume,andPSAD were significantly related to the differences in postoperative Gleason score,and the prostate volume can be used as an independent predictor of the difference.When the prostate volume is 0.78,it has higher diagnostic accuracy.