The Application Of TRUS/mp-MRI Fusion Imaging Targeted Biopsy In Prostate Biopsy With Serum PSA In 4～10ng/mL

Objective:To investigate the application of Transrectal ultrasound(TRUS)and multi-parametric Magnetic Resonance Imaging(mp-MRI)fusion imaging targeted biopsy in prostate biopsy with serum Prostate specific antigen(PSA)in 4～10ng/mL.Transrectal or transperineal prostate biopsy is often used in the diagnosis of early Prostate cancer(PCa),but the false negative rate of these two methods is higher,especially when the serum PSA is 4～1Ong/mL,the detection rate is lower.In order to avoid missed diagnosis,the traditional method is to use multiple biopsys or saturated biopsys,but more biopsys and needles will not only increase the patient’s pain,but also increase the incidence of complications.In the context of the increasing incidence of PCa,we hope to achieve early detection,early diagnosis and early treatment for PCa patients located in the PSA interval of gray area,so as to improve the survival rate of patients.At the same time,it is also hoped that in order to avoid over-treatment,clinically significant PCa(csPCa)can be distinguished from early PCa to guide clinical active treatment,and active monitoring of non-clinically significant prostate cancer(nsPCa)can be adopted.How to improve the early diagnosis rate of PCa in patients with serum PSA value of 4～10ng/mL,and to diagnose csPCa as early as possible,reduce the detection of potential and non-clinically significant tumors and avoid inappropriate clinical treatment are important issues in clinical diagnosis and treatment.Methods:1.Clinical study of TRUS and mp-MRI fusion imaging guided transperineal prostate targeted biopsy in the diagnosis of prostate cancer with serum PSA in 4～10ng/mL.Retrospective analysis of patients with serum PSA of 4～10ng/mL and suspected cancer detected by mp-MRI in Foshan First People’s Hospital from January 2020 to June 2022 who underwent TRUS/mp-MRI fusion navigation guided transperineal prostate biopsy.The patient’s age,PSA value,prostate volume,number of biopsy needles,number of positive needles,PI-RADS v2 score,Gleason score,apparent diffusion coefficient ADC)value,and complications were collected.Finally,SPSS 22.0 statistical software was used for processing.The measurement data of normal distribution were expressed as x±s.The independent sample t test was used for comparison between groups,and the χ2 test was used for comparison of rates.p<0.05 was considered statistically significant.By constructing the receiver operating characteristic curve(ROC),the area under the curve(AUC),sensitivity,specificity and accuracy were obtained to determine the optimal diagnostic threshold and evaluate its diagnostic value.2.The application of TRUS and mp-MRI fusion imaging targeted biopsy in repeated prostate biopsy with serum PSA in 4～10ng/mL.Methods:1.A retrospective analysis of 225 patients with suspected prostate cancer who were treated in Foshan First People’s Hospital from January 2020 to June 2022.The serum PSA was 4～10ng/mL,the mp-MRI examination found suspicious lesions and the previous biopsy results were negative,and the need for repeated biopsy.There were 68 cases of transrectal biopsy,113 cases of perineal biopsy,and 44 cases of TRUS/mp-MRI fusion navigation-guided biopsy.The patient’s age,PSA value,prostate volume,number of biopsy needles,number of positive needles,PI-RADS v2 score,Gleason score,and complications were collected.The statistical software SPSS 22.0 was used to analyze and process the research data.The pathological results of prostate biopsy were used as the gold standard to compare and analyze the biopsy-related indicators.The count data were expressed as%,the measurement data were expressed as x±s,the measurement data were compared by t test,and the count data were compared byχ2 test.p<0.05 was considered statistically significant.Results:1.Clinical study of TRUS and mp-MRI fusion navigation guided transperineal prostate biopsy in the diagnosis of prostate cancer in serum PSA of 4～10ng/mL.A total of 82 cases were included in this study;aged 50-87 years,with an average age of(68.0±9.2)years;a total of 82 lesions(the lesion with the highest PI-RADS v2 score or the largest diameter was taken when mp-MRI showed multiple suspicious lesions in the same patient)were targeted biopsied.The diameter(the maximum diameter of the lesion on the DWI cross-sectional image)was 0.3cm-3.4cm,with an average of(1.0±0.6)cm;among them,22 cases(26.8%)were≤0.5 cm,33 cases(40.2%)were 0.6cm～1.0cm and above,and 27 cases(32.9%)were>1.0cm.All 82 lesions were successfully biopsied and confirmed by pathological diagnosis.In the TRUS/mp-MRI fusion navigation group,Gleason score was 6 in 4 cases(4.9%).7 in 13 cases(15.9%),8 in 9 cases(11.0%),9 in 11 cases(13.4%)and 10 in 8 cases(9.8%).In the systematic biopsy group,Gleason score was 6 points in 7 cases(8.5%),7 points in 6 cases(7.3%),8 points in 7 cases(8.5%),9 points in 5 cases(6.1%),and 10 points in 3 cases(3.7%).The detection rates of csPCa with PI-RADS v2 score of 3,4 and 5 were 25,0%,54.5%and 83.3%.In the TRUS/mp-MRI fusion navigation group,49 cases(59.8%)were diagnosed by biopsy,and 45 cases(54.9%)were detected by csPCa(Gleason score≥7).In the systematic biopsy group,28 cases(34.1%)were diagnosed by biopsy,and 21 cases(25.6%)were detected by csPCa(Gleason score≥7).The biopsy diagnosis rate was statistically different between the two groups(p=0.008),and the csPCa detection rate was statistically different between the two groups(p=0.001).Taking the results of targeted biopsy pathology as the gold standard,the ROC curve of ADC value was constructed,and the AUC was 0.930,the Youden index was 0.746,and the optimal diagnostic boundary value was 0.884×10-3mm2/s.Taking≤0.884×10-3mm2/s as the boundary value for diagnosing PCa,the sensitivity,specificity and accuracy were 83.7%,90.9%and 93.0%.Common complications include infection,bleeding,vagus nerve reflex,acute urinary retention,erectile dysfunction,etc.There were 14 cases(17.1%)of complications in 82 patients in the study cohort,including 9 cases(11.0%)of bleeding,2 cases(2.4%)of infection,1 case(1.2%)of vagus nerve reflex,2 cases(2.4%)of acute urinary retention,and 0 case of erectile dysfunction.The incidence of various complications was basically consistent with the literature.2.The application of TRUS and mp-MRI fusion imaging targeted biopsy in repeated prostate biopsy with serum PSA of 4～10ng/mL.This study included three groups of patients,including 68 cases of transrectal biopsy,age(70.5±8.1)years,PSA(6.7±1.6)ng/mL,prostate volume(40.2±13.5)mL,PI-RADS v2 score(3.8±0.9)points;there were 113 cases of perineal biopsy,aged(68.8±8.4)years,PSA(6.9±1.6)ng/mL,prostate volume(40.0±13.8)mL,PI-RADS v2 score(3.8±0.9).There were 44 cases of TRUS/mp-MRI fusion navigation guided biopsy,aged(69.1±8.2)years old,PSA(7.3± 1.6)ng/mL,prostate volume(44.0±14.8)mL,and PI-RADS v2 score(3.7±0.9).There was no significant difference in general data between the groups(p>0.05).In the transrectal group,21 cases of PCa were detected,including 15 cases of csPCa;in the perineal group,37 cases of PCa were detected,including 26 cases of csPCa;in the targeted group,24 cases of PCa were detected,including 20 cases of csPCa.The detection rates of PCa and csPCa in the three groups were statistically significant.There was no significant difference between the transrectal group and the perineal group.The targeted group was statistically different from the transrectal group and the perineal group.In terms of complications,there were 13 cases of infection,10 cases of hematuria,7 cases of bloody stool,5 cases of urinary retention,2 cases of vagus nerve reaction and 0 case of erectile dysfunction in the transrectal group.In the perineal group,there were 3 cases of infection,26 cases of hematuria,0 case of bloody stool,8 cases of urinary retention,3 cases of vagus nerve reaction and 1 case of erectile dysfunction.In the targeted group,there were 0 cases of infection,3 cases of hematuria,0 cases of bloody stool,1 case of urinary retention,1 case of vagus nerve reaction,and 0 cases of erectile dysfunction.The incidence of infection and bloody stool in the transrectal group was statistically significant compared with the transperineal group and the targeted group.The incidence of hematuria in the transperineal group was higher.Conclusion:TRUS/mp-MRI fusion targeted biopsy can early detect PCa and distinguish csPCa in patients with serum PSA of 4～10ng/mL.In patients with repeated biopsy,it can significantly improve the detection rate of PCa and csPCa.When ADC≤0.884×10-3mm2/s,it can significantly improve the detection of PCa,which has a good guiding role for the next clinical treatment.