| Objective: To explore the clinical characteristics of the patients with prostate cancer in Xinjiang Uygur and Han nationality, to compare the positive rate of prostate cancer by MRI combined with ultrasound guided and conventional ultrasound guided system,analysis the dynamic monitoring of PSA changes on the prognosis of the judgment in patients with advanced metastatic prostate cancer after endocrine therapy. Methods: 1)Retrospective analysis of the period from January 2007 to December 2015 the following urinary tract symptoms and age more than 50 years between two group patients, to carry out PSA examination, rectal examination and prostate ultrasound, MRI examination, the positive rate and pathological grading of prostate cancer with different ages of tPSA and different tPSA levels were compared and analyzed in Han and Uygur. 2) From January2016 to August, 253 patients with suspected prostate cancer patients in before the biopsy was recommended for multi parameters of magnetic resonance(mpMRI), and 12 point system of prostate biopsy(systemic biopsy, SB) and MRI combined with TURS targeted biopsy(MRI-US target, biopsy, TB), the value of the positive rate of biopsy and diagnostic evaluation two kinds of methods. 3) From Department of Urology of the First Affiliated Hospital of Xinjiang Medical University, from January 2005 to December 2014 during combined endocrine therapy(goserelin acetate + bicalutamide) in 236 cases of advanced metastatic prostate cancer patients. Collection of clinical data include: medical history,rectal examination(DRE), laboratory tests, imaging and pathological findings, endocrine therapy after the monthly serum PSA. The end point was the presence of castration resistance(CRPC). The follow-up deadline was July 1, 2016. Finally included in the study parameters included: initial serum PSA concentration, serum PSA concentration after treatment, serum PSA level of time to reach the valley, the emergence of castration resistance time. Single and multi factor COX regression analysis was used to compare thepredictive value of the critical value of the dynamic parameters of PSA at different levels.Results: 1) 1270 cases of prostate biopsy were investigated in this study. 988 cases of Han,282 cases of the Uygur, the age range of 55~88 years old, the average age of 70.29 + 7.88 years old. 2) Uygur and Han tPSA values were compared, the difference was statistically significant(P<0.05), the tPSA value of the Uygur group was lower than that of the Han.TPSA values of different ages were compared, the difference was statistically significant(P < 0.05). 3) 1270 cases of patients with prostate biopsy, pathological diagnosis of prostate cancer was 494 cases, the positive rate of total prostate biopsy was 38.9%. There were significant differences in the positive rates of prostate cancer in different tPSA levels(P<0.05), and the positive rates of different ethnic groups were statistically significant(P<0.05). There was significant difference in the detection rate of prostate cancer between the different PSA density and the different race(P < 0.05). 4) Frequentce, dysuria and back pain as the main symptom, clinical stage IV, high-risk patients accounted for 93.1%,tPSA<20 ng/ml accounted for only 30.3%, Gleason score more than 8 points accounted for 46%. 5).The results of logistic regression showed that age, t PSA, nationality, PSA density and BMI were the important factors influencing the occurrence of prostate cancer.6) The positive rate was 47.5%(67/141) in 141 patients with prostate biopsy guided by multi-parameter magnetic resonance(mpMRI) and ultrasound guided prostate biopsy,According to the level of serum PSA, the positive rate of prostate biopsy was 23.7%(14/59), 35.5%(11/31), 66.7%(16/24) and 96.3%(26/27). 7) In patients with PSA <10ng/ml MRI sensitivity and specificity were 85.7% and 75.6%(34/45), combined with puncture sensitivity of 91%(14/14), compared with the traditional ultrasound sensitivity increased by 50%(7/14); MRI sensitivity and specificity were 72.7% and 85% in 10 ng/ml<PSA<20ng/ml patients, combined with puncture sensitivity was 72.7%, compared with the traditional ultrasound sensitivity increased by 36.4%; the sensitivity and specificity of MRI were 97.8% and 75% in 20 ng/ml < PSA < 50 ng/ml patients, combined with puncture sensitivity was 97.8%, compared with the traditional ultrasound sensitivity increased by 50%; the sensitivity and specificity of MRI were 100% and 100% in PSA or50ng/ml patients, with a sensitivity of 100% puncture. 8) A total of 332 cases were collected in this study, the age range was 50-90 years old, and the median age was 75 years. The median follow-up time was 48.7 months, and the number of lost to follow-up was 16(4.8%). All patients were treated with medical castration + goserelin bicalutamide as endocrine therapy. Before treatment, the average value of PSA: 206.44±46.97ng/ml,median value: 78.8ng/ml. Mean PSA valley was 3.10±0.80ng/ml. 9) single factor andmulti factor COX regression of risk factors related to prognosis after screening found that the overall risk of death, Gleason score(HR=1.397, P=0.020) is normal(HR=0.108,P=0.004) and PSA are decreased to undetectable levels(HR=0.205, P=0.000) and PSA(HR=0.889, valley time P=0.000) is an independent risk factor. The risk of cancer death,only PSA is back to normal(HR=0.128, P=0.014) and PSA are decreased to undetectable levels(HR=0.128, P=0.000) and PSA(HR=0.889, P=0.000) valley time were independent predictors of cancer specific death. Biochemical recurrence, only PSA is back to normal(HR=0.461, P=0.032, PSA) are decreased to undetectable levels(HR=0.388, P=0.000)and PSA(HR=0.950, P=0.000) valley time are independent risk factors for disease progression. 10) combined with the relationship between PSA dynamic parameters and prognosis of the different levels of the PSA valley after the discovery, the absolute level is lower and the PSA normal time is shorter and the PSA valley time is longer, PSA half longer, with better prognosis. ROC curve analysis showed that the sensitivity of PSAS was65.7% when the 0.2ng/ml value was the best critical value, and the specificity was 80.6%.PSA valley values greater than 0.2ng/ml suggest poor prognosis. For the PSA of the valley time, 10 months for the most appropriate critical value, the sensitivity was 71.6%; the specificity was 63.9%. The patient's prognosis is better than the 10 months of the valley.11) Using the Logistic regression method, EOD score(OR=2.489, P=0.000) is an independent risk factor of PSA can not reach the normal level after treatment; cause PSA can not be reduced to the risk factors of 0.2ng/ml, only the EOD score has clinical significance(OR=1.871, P=0.002). Conclusions: The number of prostate cancer patients showed an increasing trend year by year, suggesting that the prevention and control of prostate cancer in Xinjiang area is still grim. The main symptom of prostate cancer is frequent micturition, dysuria and back pain, and prostate hyperplasia and/or other elderly chronic diseases were similar, early detection and early diagnosis difficult. Clinical stage IV, high-risk patients accounted for 93.1%, tPSA<20ng/ml accounted for only 30.3%,Gleason score more than 8 points accounted for 46%. The above characteristics of prostate cancer in Xinjiang region found late, late clinical stage, early screening and early detection for prostate cancer prevention and treatment is of great significance. Logistic regression analysis showed that age, tPSA, PSA, BMI, national density effect is an important factor in prostate cancer, prostate biopsy in Uygur patients in Xinjiang area were detected in different age and different t PSA level of tPSA in prostate cancer rate was lower than the same level of the Han population, between two groups in pathological grade are more than a uniform, but there are no statistical difference. Linear correlation analysis showed thatthere was a correlation between the detection rate of prostate cancer and the age of the Han nationality and the Uygur nationality, and the level of PSA. PSA Valley, PSA valley time, PSA normalization and PSA decreased to undetectable levels and patients' overall survival, cancer specific survival and recurrence of the three biochemical outcomes were significantly associated, which indicates the application value of PSA dynamic changes in endocrine therapy for patients with prostate cancer after monitoring the. PSA reached the valley for longer periods of time, the prognosis is better, which is inconsistent with the traditional clinical experience, the need for further research to verify the results and explain the reason. In addition, the shorter the PSA, the better the prognosis is. The optimal critical value of PSA valley value is PSA, and the optimal critical value of 2ng/ml valley time is 10 months. The EOD score and Gleason scores were correlated with the prognosis, and more with the EOD score after treatment in patients with PSA can drop to less than 4ng/ml and less than or equal to 0.2ng/ml correlation. |
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