Analysis Of Related Factors For The Upgrading Of Gleason Score After Radical Prostatectomy

Objective:To explore the factors that may lead to the upgrading of Gleason score(GS)after radical prostatectomy(RP).Methods:Patients who underwent prostate biopsy and underwent RP at the Department of Urology of Shandong Provincial Hospital between September 2019 and December 2021 were collected.According to strict inclusion criteria and exclusion criteria,a total of 135 patients were included in this study.We collect patients’ data through the medical record system,conduct a retrospective study on factors that may lead to GS upgrading.The research factors included:age,body mass index(BMI),PSA value before prostate biopsy,Neutrophil-to-lymphocyte ratio(NLR),prostate volume(PV),total number of needles of prostate biopsy,number of positive needles of prostate biopsy,proportion of tumor in prostate biopsy tissue,prostate biopsy method,and prostate biopsy GS.According to the GS after prostate biopsy and RP,the patients were divided into the GS upgrading group and the GS non-upgrading group,and the data between the two groups were compared.Univariate logistic regression analysis was used to compare the effects of each factor on GS upgrading,and multivariate logistic regression analysis was performed for the indicators with statistically significant differences.Using the GS after RP as golden standard,the ROC curve of risk factors was drawn to evaluate the predictive value of risk factors for GS upgrading.Results:Among the 135 patients in this study,32 patients(23.7%)had GS upgraded after RP,77 patients(57.0%)had consistent GS,and 26 patients(19.3%)had GS downgraded.Comparative analysis of the data between the GS upgraded group and the GS non-upgraded group,PV(P=0.038),FPSA(P=0.017)and PS AD(P=0.006)were associated with postoperative GS upgrading(P<0.05),which have statistical significance.Age(P=0.870),BMI(P=0.331),TPSA before prostate biopsy(P=0.076),FPSA/TPSA(P=0.570)value,NLR(P=0.361),total number of needles for prostate biopsy(P=0.604),the number of positive needles for prostate biopsy(P=0.638),the positive needle rate of prostate biopsy(P=0.521),the proportion of tumors in positive needle tissue(P=0.887),and the proportion of tumors in all prostate biopsy tissues(P=0.904)had no significant difference,which have no statistical significance.There was no significant difference between cognitive fusion prostate biopsy and targeted fusion prostate biopsy.Different GS of prostate biopsy have no statistical significance on post-RP GS upgrading as well.Logistic regression analysis was performed on PV,FPSA and PSAD,which had statistically significant differences in GS upgrading after RP compared with prostate biopsy GS.The results showed that PS AD(P=0.002)was a risk factor for GS upgrading,and PV(P=0.043)was a protection for GS upgrading.The multivariate logistic regression of the two showed that only PSAD(P=0.006)was an independent predictor of GS upgrading after RP.For every 0.1ng/mL2 increasing in PSAD,the possibility of GS progression increased by 1.104 times.The ROC curve was constructed according to the algorithm.The AUC=0.660.When PSAD=0.505ng/mL2,the sensitivity of PSAD in identifying GS upgrading was 65.60%,and the specificity was 58.3%.So PSAD=0.505ng/mL2 is the cut-off value.Conclusion:1.There is a phenomenon of GS upgrading after RP.2.PV and PSAD can be used as predictors of GS upgrading.Prostate cancer patients with small PV and high PSAD are more prone to GS upgrading.3.PSAD is an independent predictor of GS upgrading.For patients with PSAD>0.505 ng/mL2,repeat prostate biopsy if necessary,and adjust the treatment plan in time.