| Purpose:To explore the diagnostic value of transperineal prostate targeted puncture guided by multi-parameter magnetic resonance and transrectal ultrasound cognitive fusion imaging in prostate cancer.Method:hospital for suspected prostate cancer from July 2020 to January 2021.All patients underwent MRI-TRUS cognitive fusion targeted biopsy(MRI-TB)+ systematic biopsy(SB),record the patient’s age,total prostate specific antigen(TPSA),free PSA(f PSA),FPSA/TPSA,PSA density(PSAD),prostate volume,Glenson score;compare MRI-TB and SB with statistical methods The difference between MRI-TB+SB and MRI-TB+SB in the detection of prostate cancer,the difference in single needle positive rate,the difference in the detection of MRI-TB and SB in cs PCa,and the detection value of MRI-TB and SB under different PSA and PSAD.Result:A total of 99 patients were enrolled.The patients were 48-92 years old,with an average age of(69.79±8.72)years old.The prostate volume was 10.81~204.33 ml,the median volume was 43.47ml(29.03,67.91);the total serum PSA concentration(TPSA)was 3.32~474.80 ng/ml,the median TPSA concentration was 27.32ng/ml(15.94,86.78),including 1 patient with TPSA<4ng/ml,5 patients with 4≤TPSA< 10ng/ml,33 patients with 10≤TPSA<20ng/ml,60 patients with TPSA≥20ng/ml;serum free PSA concentration(f PSA)was 0.71 ~ 60.00ng/ml,median f PSA concentration was 3.27ng/ml(1.77,10.52);PSA density(PSAD)was 0.01 ~16.64ng/ml3 The median PSAD was 0.62 ng/ml3(0.31,1.53),including 4 patients with PSAD<0.15ng/ml3,18 patients with 0.15≤PSAD<0.30 ng/ml3,27 patients with 0.30≤PSAD<0.60 ng/ml3,There were 23 patients with 0.60≤PSAD<1.20 ng/ml3 and 27 patients with PSAD>1.20 ng/ml3;f PSA/TPSA was 0.04-0.42,and the median f PSA/TPSA was 0.13(0.10,0.17).A total of 81 cases of prostate cancer were detected in 99 patients,the detection rate was 81.82%,of which 79 cases were prostate adenocarcinoma(80%),of which 66 cases(66.67%)were clinically significant prostate cancer(cs PCa),and clinically non-significant prostate cancer 13 cases(13.13%)of cancer(cis PCa),1 case of squamous cell carcinoma(1.01%),1 case of ductal carcinoma(1.01%),18 cases(18.18%)of prostate hyperplasia or inflammatory changes were detected.SB method detected 66 cases of prostate cancer(66.67%),50 cases of cs PCa(50.51%),14 cases of cis PCa(14.14%),1 case of ductal carcinoma(1.01%),1 case of squamous cell carcinoma(1.01%),prostate hyperplasia and(Or)33 cases of inflammatory changes(33.33%).MRI-TB method detected 69 cases of prostate cancer(69.70%),30 cases(30.30%)of prostate hyperplasia and/or inflammatory changes,62 cases(62.63%)of cs PCa and 13 cases of cis PCa(6.06%)of prostate cancer),1 case of ductal carcinoma(1.01%).In the total detection rate of prostate cancer,MRI-TB+SB(81.82%)>TB(69.70%)>SB(66.67%),the difference is statistically significant(P = 0.004),MRI-TB and SB comparison,in There was no difference in the detection of prostate cancer(P>0.05);the single-needle positive rate of MRI-TB was 69.70%(138/198)> the single-needle positive rate of SB method was 47.98%(507/1188),and there was a difference between the two Statistical significance(2=10.004,P=0.002);MRI-TB is significantly better than SB in the detection of cs PCa,and there is a significant difference between the two,which is statistically significant(P=0.0037).Targeted puncture and systematic puncture under different TPSA levels and PSAD showed no difference in the detection of prostate cancer(P>0.05),but with the increase of TPSA concentration and PSAD,the detection rates of the two methods both increased.Conclusion:MRI-TRUS cognitive fusion targeted biopsy is a clinically feasible puncture method.There is no difference between the overall prostate cancer detection rate and system biopsy in patients with positive mpMRI examinations.System biopsy combined with targeted biopsy can increase the detection rate of prostate cancer,Reduce the possibility of missed diagnosis of prostate cancer;cognitive fusion targeted biopsy has a higher single needle positive rate and can detect prostate cancer with higher Gleason score with fewer needles;combination of PSA and PSAD before surgery can improve the detection of prostate cancer rate. |
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