The Value Of Prostate Volume Index In The Diagnosis Of Prostate Cancer In Patients With Serum TPSA 4-10ng/ml

Objective: To evaluate the value of Prostate volume index(PVI)in the diagnosis of Prostate cancer in patients with serum TPSA 4-10 ng/ml.Methods: The clinical data of 837 patients with suspected prostate cancer at TPSA level of 4-10ng/ml from January 2013 to December 2018 were analyzed retrospectively.General data,body mass index(BMI),serum total PSA,free PSA,free / total PSA(F/T PSA),PSA density(PSAD)were collected.According to the exclusion criteria,146 cases were excluded,and the remaining 691 cases were examined by prostate MRI and transrectal prostate biopsy.According to the results of MR,total prostate volume(TPV),transitional zone volume(TZV),peripheral zone volume(PZV)and prostate volume index(PVI)were calculated.According to the pathological results,the patients were divided into prostate cancer(PCA)group and benign prostatic hyperplasia(BPH)group.Single factor Logistic analysis was used to compare the differences of the two groups,and then the factors of statistical differences were analyzed by logistic multiple factor regression analysis to further find and predict the influencing factors of prostate cancer diagnosis.ROC was used to evaluate the predictive effect of independent predictors on the diagnosis of prostate cancer.Results: Eventually,691 patients were enrolled,The overall age of the patients was 68.76±8.06(51-79)years old,BMI 24.21±3.23(16.65-35.38)kg/m2,serum total PSA 6.92±1.69(4-9.97)ng/ml,F/T PSA(%)16.39±9.94(6.12-53.72),PSAD 0.175±0.087(0.038-0.622)ng/ml,PV 46.73±19.85(13.62-152.04)ml,PVI1.02±0.24(0.51-1.55).According to the biopsy pathological results,242 cases(35.02%)of prostate cancer and 449 cases(64.98%)of benign prostatic hyperplasia were diagnosed.There was no significant difference in Age,BMI and PSA between the two groups(P = 0.164,0.051 and 0.107,respectively).There were significant differences in F/T PSA,PSAD,PV and PVI between the two groups(P < 0.001).Further multivariate regression analysis revealed that F/T PSA(P<0.001,OR=0.929),PSAD(P<0.001,OR=1.122),PV(P =0.040,OR=0.917)and PVI(P<0.001,OR=0.001)were independent predictors of prostate cancer diagnosis in patients with PSA 4-10ng/ml.According to ROC curve analysis,the AUC of F/T PSA,PSAD,PV and PVI in the diagnosis of prostate cancer were 0.684,0.690,0.697 and 0.833,respectively.The AUC value is sorted as PVI,>,PV,>,PSAD,>,F/T PSA.The optimal cut-off value of F/T PSA was 0.301,and the sensitivity and specificity were 62.40% and 67.71%,respectively.The optimal cut-off value of PSAD was 0.299,and the sensitivity and specificity were 58.68% and 71.27%,respectively.The optimal cut-off value of PV was 32.0ml,and the sensitivity and specificity were 47.11% and 91.76%,respectively.The optimal cut-off value of PVI was 1.00,and the sensitivity and specificity were 86.36% and 66.15%,respectively.Conclusion: In patients with suspected prostate cancer with serum TPSA level of 4-10ng/ml,F/T PSA,PSAD,PV and PVI were independent predictors of the diagnosis of prostate cancer.PSAD(P < 0.001,OR= 1.122)was the risk factor of prostate cancer diagnosis,F/ T PSA(P < 0.001,OR= 0.929),PV(P = 0.04,or= PVI(P < 0.001,OR= 0.001)is a strong protective factor for the risk of prostate cancer.Compared with F/T PSA,PSAD and PV,PVI has a better diagnostic advantage for prostate cancer.For suspected prostate cancer patients with TPSA level of 4-10 ng / ml,PVI can be used as a reference factor to assist in judging whether to consider prostate biopsy.