| Objective:To explore the independent predictors of clinically significant prostate cancer(csPCa);to investigate the value of targeted puncture guided by cognitive fusion of biparametric magnetic resonance imaging(bpMRI)and transrectal ultrasound(TRUS)in the diagnosis of prostate cancer.Methods:The data of 60 patients who underwent systematic biopsy(SB)in the Department of Urology of Nanchong Central Hospital Affiliated to North Sichuan Medical College from January 2021 to December 2021 were collected to determine the benign and malignant prostate diseases.Before puncture,two parameter magnetic resonance imaging was routinely performed and scored according to the scoring rules of prostate imaging report and data system version 2.1(PI-RADS v2.1),among them,50 patients had PI-RADS v2 1 score≥ 3,additional targeted biopsy(TB)was performed.The patient’s name,age,tPSA,fPSA,f/tPSA,PV,PS AD and PI-RADSv2.1 score and Gleason score were recorded in detail.According to the pathological results,they were divided into clinically significant prostate cancer group(patients with Gleason score≥ 7)and clinically insignificant prostate cancer group(including patients with Gleason score=6 and benign prostatic lesions).Independent sample t-test or rank sum test were used to compare the difference of clinical data between the two groups.Logistic regression was used to analyze the statistically significant index variables,and to explore the independent predictors of clinically significant prostate cancer.According to the puncture methods,the patients who underwent systematic puncture+targeted puncture were divided into systematic puncture group,targeted puncture group and systematic+ targeted combined puncture group.The detection rates of the three puncture methods in prostate cancer were compared by Pearsonχ2test or Fisher exact probability method,to compare the difference of single needle positive rate between systematic puncture and targeted puncture,the difference of detection rate in clinically meaningful prostate cancer,and the difference of detection rate of prostate cancer in different PSA levels.Results:Among the 60 patients included in the study,there were 29 patients with cisPCa and 31 patients with csPCa.The results of independent sample t-test or rank sum test showed that there was no significant difference in age,body mass index,plasma lactic acid and PV between the two groups(P>0.05).There were significant differences in tPSA,fPSA,f/tPSA,PSAD and PI-RADS v2.1 score between the two groups(P<0.05).The results of multivariate analysis suggest that PI-RADS v2.1 score was an independent predictor of csPCa.50 patients underwent systematic+targeted biopsy.In the total detection rate,systematic biopsy+targeted biopsy(74%)>systematic biopsy(70%)>targeted biopsy(66%),but the difference was not statistically significant(P>0.05);the single needle positive rate of targeted biopsy method was 50.60%(85/168)>the single needle positive rate of sb method was 36.27%(259/714),and the difference was statistically significant(χ2=11.724,P=0.001);there was no significant difference between SB and TB in the detection rate of csPCa(P>0.05);there were 12 patients with tPSA<10ng/ml,8 patients with 10ng/ml ≤tPSA<20ng/ml and 30 patients with tPSA≥20ng/ml.there was no significant difference in the detection rate of PCa between system biopsy and targeted biopsy in different PSA levels(P>0.05).Conclusion:PI-RADS v2.1 score is an independent predictor of csPCa;In patients with PI-RADS score≥3,there was no difference in the detection rate of prostate cancer between targeted puncture and systematic puncture and combined with targeted systematic puncture;there was no significant difference between targeted puncture and systematic puncture in detecting clinically significant prostate cancer;in different levels of tPSA,the efficacy of targeted puncture and systematic puncture in detecting prostate cancer was the same;targeted puncture has a higher positive rate of single needle,which can detect prostate cancer and clinically significant prostate cancer with less needles. |
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