Value Of Combined Use Of DWI,TPSA,FPSA And FPSA/TPSA In Diagnosing Of Prostate Cancer And Correlation With Gleason Score

Objective:To evaluate the value of diffusion weighted imaging（DWI）combined with prostate specific antigen series in the diagnosis of prostate cancer and their correlation with Gleason score.Methods:The MRI data and clinical data of 30 patients with prostatic hyperplasia and 30 patients with prostate cancer in the second Hospital of Hebei Medical University dated from January 2016 to July 30th 2017 were analyzed retrospectively.All patients underwent conventional MRI sequences and DWI before prostatic puncture.The ADC values of DWI were recorded in patients with prostatic hyperplasia and in patients with prostate cancer compared with the results of biopsy.The prostate specific antigen TPSA,FPSA,FPSA/TPSA and the pathological Gleason score of prostate cancer were collected and recorded.The difference of ADC,TPSA,FPSA and FPSA/TPSA between prostate cancer patients and patients with prostatic hyperplasia was analyzed by using independent-sample t-test.The single and combined diagnostic value in the diagnosis of prostate cancer was analyzed by ROC curve.According to the Gleason score,patients with prostate cancer were divided into groups.Independent-sample t-test and Wilcoxon-rank test were used to compare the ADC,TPSA,FPSA and FPSA/TPSA in different Gleason score groups.Spearman correlation analysis was used to analyze the correlation between ADC,TPSA,FPSA and FPSA/TPSA and Gleason score in prostate cancer patients.Results:1.the ADC,TPSA,FPSA and FPSA/TPSA was（0.74±0.16）×10^-3mm²/s,（52.23±41.36）ng/ml,（6.78±6.34）ng/ml and（0.13±0.07）ng/ml in prostate cancer group,while（1.27±0.29）×10^-3mm²/s,（10.75±7.58）ng/ml,（2.98±2.43）ng/ml and（0.29±0.14）ng/ml in prostatic hyperplasia group.The value of ADC and FPSA/TPSA in prostate cancer group was lower than that of the prostatic hyperplasia group.The value of TPSA and FPSA in the prostate cancer group was higher than that of the prostatic hyperplasia group.The differences between the two groups were significant（P<0.001）.2.The area under the ROC curve（AUC）of ADC,TPSA,FPSA and FPSA/TPSA for the diagnosis of prostate cancer was 0.963,0.950,0.702 and0.887 respectively.The AUC of ADC combined with TPSA,FPSA,F/TPSA for the diagnosis of prostate cancer was 0.970,0.963 and 0.984 respectively.Except FPSA alone had a lower diagnostic efficacy,all the other single indexes were of high diagnostic value,and the value of ADC was the highest.The areas under the curve of prostate-specific antigen combined with ADC increased,which could improve the diagnostic value of prostate cancer.The diagnostic value of ADC combined with F/TPSA was the greatest.3.The ADC,TPSA,FPSA and FPSA/TPSA in the differentiated group（Gleason score 5-7）was（0.83±0.19）×10^-3mm²/s,26.68（18.84,47.46）ng/ml,2.86（1.68,9.07）ng/ml and 0.16±0.09 respectively,while（0.67±0.10）×10^-3mm²/s,55.03（33.26,88.55）ng/ml,4.00（2.78,9.74）ng/ml and 0.10±0.04 in the poorly differentiated group（Gleason score 8-10）.There were significant differences between ADC,TPSA and FPSA/TPSA group（P<0.05）,but there was no significant difference between the FPSA group（P=0.267）.4.The correlations between Gleason score,ADC,TPSA,and FPSA/TPSA were statistically significant.There were negative correlations between Gleason score with ADC and FPSA/TPSA（R=-0.398,P=0.030;R=-0.539,P=0.002）,and a positive correlation between Gleason score with TPSA（R=0.423,P=0.020）.The Gleason score increased with the decrease of ADC and FPSA/TPSA and with the increase of TPSA.There was no statistical significance in the correlation analysis between the Gleason score and the FPSA（P=0.491）,There was no linear correlation between Gleason score and FPSA.Conclusion:1.Magnetic resonance diffusion weighted imaging（DWI）and serum prostate specific antigen（PSA）are of great value for the diagnosis and differential diagnosis of prostate cancer.ADC value measurement has higher diagnostic value for prostate cancer.The combination of ADC and PSA can improve the diagnostic efficiency and the diagnostic value of ADC combined with FPSA/TPSA is the largest.2.The Gleason score of prostate cancer has a certain correlation with the ADC value of MR diffusion weighted imaging and the level of serum prostate specific antigen.A noninvasive assessment of the Gleason score could be made according to the ADC value and the serum prostate specific antigen level.Considering the ADC value,serum prostate specific antigen level and pathological Gleason score,the biological characteristics of prostate cancer can be more fully and accurately grasped,which helps to develop more accurate treatment and prognostic evaluation.