Analysis Of Influencing Factors Of Positive Rate Of Prostate Biopsy And Prediction Model Of Prostate Cancer

BackgroundProstate cancer(PCa),which is more common in elderly men,varies greatly from region to region and race.at present,the incidence of prostate cancer in Europe and the United States has surpassed lung cancer to become the first male tumor.Globally,it has jumped to the fourth most common cancer and the second most common cancer in men[1].In China,prostate cancer has become the first malignant tumor endangering the health of male urinary system.According to the 2015 China Cancer Annual report,there are about 60300 new cases of cancer in China,accounting for 2.4%of male cancer patients and 1.4%of male cancer deaths[2].The proportion of different clinical stages of prostate cancer is also significantly different between China and Europe and the United States.among the newly diagnosed prostate cancer patients in the United States,about 81.0%of the patients have a limited clinical stage and have a good prognosis after radical surgery.The data showed that the 5-year survival rate was 90.0%[3].Among the newly diagnosed patients in China,the proportion of patients with limited clinical stage was only 30.0%.Most of the patients had local advanced or extensive metastasis at the time of diagnosis,and the prognosis was poor[2].Therefore,the early screening of prostate cancer has long-term significance for our country.Digital rectal examination(DRE),determination of serum prostate specific antigen(PSA)and transrectal ultrasound(TRUS)guided prostate biopsy are the main methods for the diagnosis of prostate cancer.In general,when the patient’s rectal digital examination or prostate B-ultrasound examination found hard prostate nodules,PSA detection is greater than 4ng/ml,further ultrasound-guided systematic prostate biopsy is required.According to the pathological diagnosis of the obtained tissue to make a preliminary diagnosis,and can be used as a reference for later treatment.The traumatic operation of prostate puncture may have a variety of complications,including hematuria,bleeding,infection,urinary retention and psychological negative effects.About 1%of patients have complications requiring hospitalization after prostate biopsy,and the incidence of false positive results and complications of biopsy is higher in older patients.Therefore,we can find alternative diagnosis and treatment options by evaluating the clinical diagnostic effectiveness of other auxiliary measures,so as to reduce unnecessary puncture procedures and overdiagnosis and treatment of prostate cancer.By exploring new diagnostic markers and imaging techniques for prostate cancer and establishing a predictive model for prostate cancer puncture,we can effectively reduce unnecessary puncture and overdiagnosis and treatment.However,the ethnic and regional differences of prostate cancer seriously affect the accuracy of prediction model,so it is imperative to study the diagnostic indicators and prediction methods of prostate cancer suitable for our country.Objection1.To investigated age,PSA,body mass index(BMI),prostate volume(PV),PSA density(PSAD)and free prostate specific antigen ratio(f/tPSA),DRE,prostate imaging reporting and data system(PI-RADS),B-ultrasound junction whether is the related influencing factor of the positive rate of prostate puncture under the guidance of transrectal ultrasound.2.To established the multivariate logistic regression prediction model of prostate cancer and compare it with the original risk prediction model of prostate puncture in China,so as to provide more accurate reference value for clinical puncture and improve the positive rate of prostate puncture.Methods and materials1.The data of patients admitted to the Nan Fang hospital from June 2015 to June 2018 were selected retrospectively.A total of 404 patients who met the inclusion criteria of the study were selected.2.Randomly selected cases 3≤4(300 cases)were divided into modeling group and 1≤4(104 cases)were divided into verification group.Two sets of data were analyzed for general baseline data.The influence level of each factor on the positive rate of prostate puncture in the modeling group was analyzed by univariate analysis.3.Multivariate Logistic regression analysis and modeling were carried out on the cases of the modeling group which were verified by the data of the patients in the validation group.And through the(Receiver operating characteristicof the subjects’working characteristics,ROC)curve to evaluate the predictive value of the model and compare it with other models.Results1.There were significant differences in age,DRE,tPSA,f/tPSA,PS AD,PV,B-ultrasound nodules and PI-RADS in univariate analysis,which proved that the above factors were the related factors of positive prostate biopsy under ultrasound guidance.There was no significant difference in BMI.2.The results of multivariate regression showed that age,DRE,PSAD,B-ultrasound and PI-RADS were the independent risk factors of biopsy,while PV was the independent protective factor of biopsy.The area under the curve(area under curve,AUC)of the prediction model is 0.929.When the result value was 0.402,the sensitivity,specificity and Jordan index were 84.70%,87.80%and 0.725,respectively.ConclusionThe Logistic multivariate regression prediction model with age,DRE,PSAD,PV,B-ultrasound and PI-RADS was superior to DRE,B-ultrasound and PI-RADS alone,and had certain advantages over the three original prediction models of prostate cancer in China.It can increase the positive rate of prostate biopsy guided by transrectal ultrasound for the first time and reduce the negative impact of overdiagnosis and treatment on patients.