| Objective:Explore multiple parameter magnetic resonance Imaging,The diagnostic value of MP-MRI PR-RADS score in prostate specific antigen(PSA)4～10ng/ml(conventional gray area)and 10～20(hypothetical gray area)for prostate cancer(PCA).Methods:In this study,147 patients with multi-parameter MRI with PSA4～20ng/ml in prostate needle biopsy in our hospital from January 2018 to June 2020 were selected and divided into two groups:patients with prostate cancer(PCA)and patients with benign prostatic hyperplasia(BPH).Age,BMI,PSAD,DRE,US,PI-RADS score(divided into groups 1～2 and 3～5 according to the PI-RADS score)and other clinical features were retrospectively analyzed.According to the PSA value,the patients were divided into two subgroups,4.0-10.0 ng/mL and 10.0-20.0 ng/mL,respectively.The positive rate of needle biopsy with different PI-RADS scores in each group was calculated,and the difference of diagnosis rate was compared.The diagnostic value of PI-RADS and PSA for prostate cancer was obtained by comparing the area under the ROC curve(AUC)of various examination methods in different PSA ranges,and the optimal bound value of PI-RADS score and PSA in different subgroups was determined according to the Youden index(Youden index=sensitivity+specificity-1).Univariate and multivariate Logistic regression analyses were performed to determine whether PI-RADS score was an independent predictor of prostate cancer.Results:A total of 149 patients were enrolled in this study,including 48 patients with prostate cancer(PCA)and 99 patients with benign prostatic hyperplasia(BPH).PSAD(P=0.0331)was less than 0.05 between the puncture pathology-positive group and the negative group,indicating a significant statistical difference.There were no significant differences in age,BMI,prostate volume,PSA ratio,DRE,US and MRI(all P>0.05).Comparison of puncture positive rates under different PI-RADS scores showed that in subgroup PSA 4.0～10.Ong/mL,with the increase of PI-RADS score,the puncture positive rate was significantly increased.In the subgroup PSA 10.1-20.0 ng/mL,it was found that the puncture positive rate was significantly increased when the PI-RADS score was 5,and the puncture positive rate was also significantly increased when 3 and 4 scores were compared with 1 to 2 scores.Within the range of PSA4.0～20.Ong/mL,the positive rate of puncture was found to increase gradually with the increase of PI-RADS score.In the subgroup of PSA 4.0-10.Ong/ml,the PI-RADS score and the AUC value of PSA were 0.754 and 0.523,respectively,in 68 patients who underwent prostate biopsy.In the subgroup of PSA 10.1-20.0ng/ml,the PI-RADS score and the AUC value of PSA were 0.745 and 0.603,respectively,among the 79 patients who underwent prostate puncture.PI-RADS score and AUC value of PSA were 0.766 and 0.586 in 147 patients with PSA 4.0～20.0ng/mL.In the subgroup of PSA 4.0～10.Ong/mL,the optimal threshold of 4 was PI-RADS,with Youden index of 52.94%,sensitivity and specificity of 58.82%and 94.12%,respectively.In the subgroup of PSA 10.1 to 20.0ng/mL,the optimal threshold of 4 was PI-RADS,with Youden index of 57.12%,sensitivity and specificity of 61.29%and 95.83%,respectively.In the PSA 4.0-20.0 ng/mL subgroup,the optimal critical point of PI-RADS was 4,the Youden index was 58.46%,the sensitivity and specificity were 62.50%and 95.96%,respectively.In Logistic regression analysis,the OR values of PI-RADS score were 3.459(P values were less than 0.05)within the PSA range of 4～20.0ng/mL,and PI-RADS was an independent predictor of the risk of prostate cancer.Conclusion:In this study,it was found that the AUC curve area of PIRADS score was larger than that of PSA in PSA4～10ng/ml(traditional gray area)and PSA10～20ng/ml(hypothetical gray area),and PIRADS score had better diagnostic efficacy for prostate cancer than PSA in traditional gray area and hypothetical gray area.The PIRADS score was an independent predictor of prostate cancer in the PSA range of 4 to 20ng/ml.It can improve the diagnostic accuracy of prostate cancer in the PSA range of 4～20ng/ml,and can avoid unnecessary prostate puncture to a certain extent,and reduce the pain of patients and related complications caused by puncture. |
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