| Objective:(1)Investigation of transrectal contrast-enhanced ultrasound parameters colour Doppler ultrasound blood flow parameters and serum exosome concentrations in the diagnosis of prostate cancer.(2)Investigating the correlation between transrectal contrast-enhanced ultrasound parameters,colour Doppler ultrasound bleeding parameters and serum concentrations of exosomes in prostate cancer.Methods:The clinical details of 60 patients with proposed prostate cancer were obtained;all patients were subjected to transrectal contrast enhanced ultrasonography and colour Doppler ultrasonography,and ultrasound-guided prostate aspiration pathological biopsy.Collection of10 ml of peripheral blood,extract serum exosomes by high-speed spinning,observe their morphology by transmission scanning electron microscopy and detect the levels of exosomes by nanoparticle tracking analysis;The group was divided into prostate hyperplasia(BPH),prostate cancer non-bone metastasis(NBM)and prostate cancer bone metastasis(BM)groups according to the results of puncture,pathology and SPECT/CT.To analyse the differences in clinical parameters among the three groups;the differences in contrast enhanced ultrasonographic parameters and colour Doppler flow parameters among the three groups;to analyse the differences in serum exosome concentrations among the three groups;the relationship between contrast enhanced ultrasonographic parameters,colour Doppler flow parameters and serum exosome concentrations in the prostate hyperplasia group,prostate cancer NBM group and prostate cancer BM group was analysed.ROC curves were plotted to assess the diagnostic efficacy of ultrasonographic parameters versus serum exosome concentrations for prostate disease.Result:Sixty patients were diagnosed with prostate hyperplasia in 20 of the cases,NBM of prostate cancer in 21 of them and BM of prostate cancer in 19 of them based on pathological findings and SPECT/CT or skeletal-related examinations.(1)The extracted serum exosomes were found to have a "teatro-like" or "biconcave" shape under electron microscopy.Analysis using a nanoparticle tracer revealed that the average and peak particle sizes were within the typical particle size range of exosomes,approximately 20-200 nm.(2)The serum exosome concentration in the BM group of prostate cancer was higher than that in the NBM and BPH groups of prostate cancer,and the serum exosome concentration in the NBM group of prostate cancer was higher than that in the BPH group(P<0.001).(3)The colour Doppler flow parameters peak systolic velocity(PSV),peak systolic velocity/end diastolic velocity(S/D)and resistance index(RI)values in the BM group of prostate cancer were higher than those in the NBM group of prostate cancer and the BPH group(P<0.001),the colour Doppler flow parameters PSV,S/D and RI values in the NBM group of prostate cancer were higher than those in the BPH group(P<0.001),and there was no discrepancy between the flow parameters EDV(P>0.05).(4)The peak intensity(PI)and area under the curve(AUC)levels of CEUS ultrasonographic parameters in the BM group of prostate cancer were higher than those in the NBM and BPH groups of prostate cancer;The contrast parameter Grad of BM group was higher than that of BPH group(P<0.001),and contrast enhanced ultrasonographic parameters PI,AUC values were higher in the NBM group than in the BPH group(P<0.001).(5)There was no significant correlation between colour Doppler ultrasound blood flow parameters and serum exosome concentration in the BM,NBM and BPH groups(all P>0.05).There was no significant correspondence between the three groups in terms of CEUS parameters and serum exosome concentrations(all P>0.05).(6)According to the ROC graphs distinguishing prostate enlargement from prostate cancer,PI,AUC,Glad and serum exosomes had the best cut-off values of 17.98 d B,1104.73 d Bs,1.51 d B/s and 2.38×E10particles/m L,respectively,and the AUC for predicting prostate cancer for the separate and combined tests were 0.83,0.86,0.75,0.90,0.98(all P<0.05),and the AUC of the combined test was greater than that of each index alone.Further differentiation of the ROC plots for prostate cancer NBM and BM showed that PI,AUC,Glad and serum exosomes had the best cut-off values of 19.33 d B,1156.63 d Bs,2.02 d B/s,3.34×E10particles/m L,respectively,and the AUC for prostate cancer BM prediction by separate and combined assays were 0.89,0.83,0.74,0.75,0.97(all P<0.05),and the AUC of the combined test was greater than that of each index alone.Conclusion : Transrectal ultrasound parameters of the prostate and serum exosome concentrations can identify benign and malignant prostate lesions and different levels of risk for prostate cancer(bone metastases,non-bone metastases);transrectal ultrasound parameters combined with serum exosomes can predict the occurrence of bone metastases in prostate cancer patients,providing an objective basis for the clinical diagnosis and treatment of prostate cancer. |
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