Influence Factors Of Gleason Scoring Accuracy In Prostate Biopsy Specimen

Objective: To investigate the reproducibility of the Gleason score after prostate biopsy and the Gleason score after radical prostatectomy,and to further analyze the causes of changes in scores and guide clinical decision-making.Methods: A retrospective analysis was performed on the clinical data of patients who underwent radical prostatectomy for prostate cancer from January 2015 to September2017 in Qingdao University Affiliated Hospital.A total of 83 patients were eligible for study.The age at the time of needle biopsy,pre-puncture tumor markers(free prostate-specific antigen(f PSA),total prostate-specific antigen(t PSA),prostate density(PSAD)),prostate volume(PV),and the number of positive needles and Indexes such as body mass index(BMI)were used to count differences in Gleason scores after puncture and radical surgery.According to the Gleason score,the patients were divided into three groups: rising,invariant,and descending.They were combined with no change and decreased.The statistical significance of each factor was compared using the t-test or ?2test.Statistically significant indexes were used in the SPSS software.Logistic multivariate regression analysis was used to determine the cause of Gleason score change in prostate biopsy,and further statistical results were obtained.Results: 83 patients met the inclusion criteria.According to the analysis,43 patients(51.8%)had preoperative puncture and radical surgery score,28 patients(33.7%)had postoperative score escalation,12 patients decreased 15.5%).With age(P = 0.82):68.96±6.9 upgrade group;The same set of 69.79 ±6.8;69.83 ± 5.5 decline in groups.Free prostate specific antigen(P = 0.12): 4.83±10.9 upgrade group;The same set of 2.41±2.0;2.45 ±3.5 decline in groups.Total prostate specific antigen(P = 0.76): 26.59 ±27.6 upgrade group;The same set of 27.40 ±21.1;16.20±15.9 decline in groups.Prostate density(PSAD)(P = 0.60): rising group of 0.67 0.80 mm;The same set of 0.65 ± 0.56;0.34 ±0.30 decline in groups.Prostate volume(P = 0.032): rising group of 38.33 14.6mm;The same set of 46.76±17.2;45.69 ±16.1 decline in groups.Positive puncture needle number(P = 0.723): rising group of 4.2 5.2 mm;The same set of 3.9 ±3.4;2.8 ± 2.6decline in groups.Body mass index(BMI)(P = 0.61).Prostate volume(P < 0.05)and puncture scores(P < 0.001)is an independent predictor of postoperative scores upgrade,further Logistic multifactor regression analysis study found that volume(OR = 0.966),Gleason score(OR = 0.386)are the points of the protective factors.Conclusion:1.Gleason score of prostate cancer biopsy is not completely consistent with Gleason score of radical prostatectomy,and there is a large proportion(33.7%)of Gleason score.2.Prostate cancer volume(P<0.05,OR=0.966)was the reason for the increase in postoperative scores,and it was a protective factor for the score upgrade after radical mastectomy.On the contrary,patients with small-size prostates are prone to score upgrade after surgery.The biopsy Gleason score(P<0.001,OR=0.386)was a protective factor for increased postoperative scores.The higher the score is,the lower the likelihood of a rise in scores after radical mastectomy,and conversely,prostate cancer patients with a low puncture score are prone to score escalation after surgery.3.The Gleason score of the biopsy was the only source to evaluate the grading of the tumor for patients who had chosen radical radiation and selected " waiting for observation" and " active monitoring ".Patients with prostate cancer with a small volume prostate and a score of 6 should be alert to underestimate the risk of tumor.