| The final pathological Gleason score of prostate cancer patients after radical prostatectomy is not completely consistent with the results of preoperative prostate biopsy.The clinical lowrisk prostate cancer with Gleason=3+3 or single positive needle biopsy is more significant.The PI-RADS scoring system based on multi-parameter magnetic resonance imaging not only makes the diagnosis of prostate cancer more accurate,but also improves the discrimination ability of high-grade prostate cancer.Therefore,it is necessary to explore the predictive value of PI-RADS score for the true pathological status of prostate cancer patients.Traditional Chinese Medicine has a unique advantage in the diagnosis and treatment of prostate cancer,but research combining traditional Chinese and western medicine for special pathological types of prostate cancer is not enough.The correlation between TCM syndrome type and clinicopathological indexes of prostate cancer patients were discussed in this study to provide the clinical basis for the syndrome differentiation and treatment of prostate cancer.Objectives:1 To investigate the predictive value of mp-MRI-based PI-RADS score in the pathological Gleason score upgrading of prostate cancer patients with prostate needle biopsy(Gleason=3+3)after radical prostatectomy.2 To investigate the predictive value of mp-MRI-based PI-RADS score in the pathological Gleason score upgrading of prostate cancer patients with single positive core by needle biopsy after radical prostatectomy.3 To explore the correlation between TCM syndrome types and clinicopathological features of prostate cancer with biopsy Gleason=3+3 or single positive core biopsy.Methods:Study one and two:We retrospectively evaluated the patients with biopsy proved prostate cancer with Gleason score=3+3 or single needle positive biopsy from January 2016 to December 2020.The clinical and pathological data including patient age,BMI,prostate specific antigen(PSA)and PSA density(PSAD),PI-RADS score,biopsy relevant data and postoperative Gleason score,etc.were collected.Univariable and multivariable logistic regression analysis was used to identify predictors of Gleason Score upgrading.Study three:A retrospective analysis using data of prostate cancer patients with biopsy Gleason=3+3 or single needle positive biopsy from January 2016 to May 2022 was performed.Prostate cancer patients confirmed by systemic needle biopsy were differentiated into different syndrome types based on the traditional Chinese medicine.The correlation between TCM syndrome type and the clinicopathological features of prostate cancer was observed.The correlation between TCM syndrome type and Gleason score upgrading after radical prostatectomy was explored.Results:Study one:A total of 157 prostate cancer patients with Gleason score=3+3 on prostate biopsy were included.The mean age was 67 years,ranged from 46 to 81 years.Before biopsy,the mean tPSA was 11.3 ng/ml,ranged from 3.1 to 45.3 ng/ml.Among 157patients,81(51.6%)had pathological Gleason score of 3+3 after radical prostatectomy,and 76(48.4%)had Gleason score≥ 7 after radical prostatectomy with Gleason score of 3+4 in 43 cases(27.4%),4+3 in 19(12.1%),4+4 in 11 cases(7.0%),4+5 in 3(1.9%).Univariate analysis showed that there were statistically significant differences in tPSA,PSAD,PI-RADS score,number of positive cores and preoperative clinical stage between patients with Gleason score upgrading after surgery and those without Gleason score upgrading(P<0.05).Multivariate Logistic regression analysis of variables showed that PI-RADS score(>3)(OR=29.3,95%CI=6.8-126.1,P<0.01),tPSA(≥10 ng/ml)(OR=5.2,95%CI=1.4-18,7,P=0.012)and PSAD(≥0.3)(OR=7.8,95%CI=2.0-30.8,P<0.01)were independent predictors of Gleason score upgrading after radical prostatectomy.Patients with multiple positive cores(≥2)had significantly lower risk of Gleason score upgrading than single positive core patients(OR=0.1,95%CI,0.0-0.3)(P<0.01).Study two:A total of 106 patients with single needle positive biopsy were included in the study,with a mean age of 68 years,ranging from 53 to 84 years.Before biopsy,the mean tPSA was 10.1 ng/mL,ranging from 3.1 to 27.9 ng/mL,including 5 cases(4.7%)with tPSA<4 ng/ml,59 cases(55.7%)with tPSA 4-10 ng/ml,34 cases(32.1%)with tPSA 10-20 ng/mL,tPSA>20 ng/ml in 8 cases(7.5%).The pre-biopsy mp-MRI PI-RADS showed 6 patients(5.7%)scored 2,31(29.2%)scored 3,65(61.3%)scored 4,and 4(3.8%)scored 5.Transrectal ultrasound guided biopsy was performed in 24 cases(22.6%)and perineal biopsy in 82 cases(77.4%).In terms of patient staging,63 cases(59.4%)had higher pathological stage after radical resection than clinical stage,4 cases(3.8%)had lower pathological stage,39 cases(36.8%)had concordant stage before and after radical prostatectomy.4 cases were assessed as bilateral lobular mass before surgery,52 cases(49.1%)had bilateral lobular prostate cancer after radical prostatectomy.Unilateral prostate cancer is underestimated in about half of cases.There were 20 cases(18.9%)with positive margins,6 of which were located at the prostatic apex.After radical prostatectomy,Gleason score upgraded in 54 cases(51%),degraded in 3 cases(2.8%),and was concordant in 49 cases(46.2%).Univariate analysis showed that there were statistically significant differences in BMI,tPSA and PI-RADS scores between patients with Gleason score upgrading and those without Gleason score upgrading after surgery(P<0.05).Multivariate Logistic regression analysis of variables showed that PI-RADS score(>3)(OR=24.9,95%CI=6.4-96.4,P<0.01),tPSA(≥10 ng/ml)(OR=2.5,95%CI=1.0-6.6,P=0.046)were independent predictors of pathological Gleason score upgrading after radical prostatectomy for single positive core prostate cancer.Study three:A total of 81 prostate cancer patients with biopsy Gleason=3+3 or single needle positive biopsy were included,including 24 cases of dampness and heat stasis syndrome,accounting for 29.6%;34 cases of phlegm and blood stasis syndrome,accounting for 42.0%;20 cases of spleen and kidney deficiency syndrome,accounting for 24.7%,2 cases of Qi and blood deficiency syndrome,accounting for 2.5%,1 case of liver and kidney Yin deficiency,accounting for 1.2%.The patients’ age ranged from 46 to 84 years with a mean age of 66.8 years.The total PSA level before biopsy ranged from 3.1 to 33.4 ng/ml,with an average of 11.2 ng/ml and a median of 9.5 ng/ml.Preoperative PI-RADS score was 3 in 34 cases(42.0%),4 in 42 cases(51.8%),and 5 in 5(6.2%).The age of patients in spleen and kidney deficiency syndrome group was significantly higher than that in dampness and heat stasis syndrome and phlegm and blood stasis syndrome group(P<0.05).The average age of patients with spleen and kidney deficiency syndrome group was 72 years old,which was significantly higher than that in dampness and heat stasis syndrome group(63.5 years old,P<0.01),and phlegm and blood stasis syndrome group(65.3 years old,P<0.01).The median tPSA level in the dampness and heat stasis syndrome group was 7.0 ng/ml,which was significantly lower than that in the phlegm and blood stasis syndrome group(9.7 ng/ml,P=0.042),and the spleen and kidney deficiency syndrome group(11.5 ng/ml,P<0.01).The proportion of hypoechoic nodules in the dampness and heat stasis syndrome group was significantly lower than that in the spleen and kidney deficiency syndrome group(P=0.015).The proportion of PI-RADS score≥ 4 in dampness and heat stasis syndrome group was significantly lower than that in phlegm and blood stasis syndrome group(P<0.01)and spleen and kidney deficiency syndrome group(P<0.01).A total of 51 patients underwent radical prostatectomy.The proportion of high Gleason score(Gleason≥7)in spleen and kidney deficiency syndrome group after radical prostatectomy was 80.0%,which was significantly higher than that in dampness and heat stasis syndrome group(42.9%,P=0.039).Among 51 patients,24 patients had an upgrading of Gleason score after operation.The proportion of patients with Gleason score upgrading in spleen and kidney deficiency syndrome group was significantly higher than that in dampness and heat stasis syndrome group(P=0.016)and phlegm and blood stasis syndrome group(P<0.01).Conclusions:1 For patients with preoperative Gleason score of 3+3,PI-RADS score(>3),tPSA,PSAD levels and the number of positive cores were independent predictors of Gleason score upgrading after radical prostatectomy.2 For patients with preoperative single needle positive biopsy,PI-RADS score(>3)and tPSA level were independent predictors for Gleason score upgrading after radical prostatectomy.The tumor load of most patients with single positive core prostate cancer was underestimated,which required clinical attention,and there was no precise indicator for accurate preoperative prediction.3 The results of this study indicate that dampness and heat stasis syndrome,phlegm and blood stasis syndrome and spleen and kidney deficiency syndrome were common TCM types of prostate cancer with biopsy Gleason=3+3 or single needle positive biopsy.There were certain correlations between TCM syndromes and clinical features of prostate cancer patients.Patients with spleen and kidney deficiency syndrome have a relatively higher PI-RADS score and a higher risk of pathological Gleason score upgrading after radical prostatectomy.TCM syndrome type can be used as an important reference element for the risk assessment of prostate cancer,and the clinical indexes of patients can also provide a certain objective basis for TCM syndrome differentiation. |
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