A Series Of Studies On Clinical Characteristics And Quality Of Life Among Patients Underwent Transrectal Ultrasound Guided Prostate Biopsy

Part I Analysis of Clinical Characteristics of Patients Underwent Transrectal Ultrasound Guided Prostate Biopsy?Objective? To assess the efficiencies of prostate-specific antigen,prostate-specific antigen density(PSAD)in the diagnosis of prostate cancer in Chinese men by ROC curve,and develop a prostate cancer Loglstic regression model to assess the possibility of positive initial prostate biopsy.?Methods? From January 2012 to July 2017,236 males underwent transrectal ultrasound guided prostate biopsy(PSA<100ng/ml)were reviewed retrospectively.Prostate cancer was detected in 78 cases.Variables analyzed,which consisted of ages,PSA,free PSA,PSAD,free to total PSA ratio(F/T PSA),Digital Rectum Examination(DRE),and TRUS results.Receiver operating characteristic(ROC)curves of the predicted probability of PSA,PSAD were conducted.Loglstic regression model was conducted to assess prostate cancer probability by SPSS software.?Results? Of the 236 subjects included in our study,33.1%(78/236)had a positive initial prostate biopsy.The PSA level in men with a positive initial prostate biopsy was statistically higher than those with a negative biopsy(34.90 � 27.69 vs 12.62 � 12.26,P<0.05)? There were significant differences in PSA,PSAD,F/TPSA,DRE and TURS findings(P<0.05)but no significant difference in age.The Areas under ROC curve of PSAD were 0.856,0.833,0.746 in Chinese males with PSA of 0~50,4~10 and 10~20ng/ml.When the best PSAD cut-off of 0.195 ng/ml/ml was used to predict prostate cancer,the specificity and sensitivity were 57.5% and 90.4%,respectively for PSA of 0~50 ng/ml;when the best PSAD cut-off of 0.144 ng/ml/ml was used to predict prostate cancer,the specificity and sensitivity were 63.2% and 90.0%,respectively for PSA of 4~10 ng/ml;when the best PSAD cut-off of 0.192 ng/ml/ml was used to predict prostate cancer,the specificity and sensitivity were 34.0% and 94.1%,respectively for PSA of 4~10 ng/ml,the efficiencies of best cut-offs for PSAD were not better than best cutoffs for PSA in diagnosis of prostate cancer.But the Areas under ROC curve of(F/T)/PSAD for predicting prostate cancer were 0.171,0.217,0.287,respectively,in Chinese males with PSA of 0~50,4~10 and 10~20ng/ml,shown the worse efficiencies of predicting prostate cancer than PSA.Independent predictors of a positive biopsy result included PSA,PSAD,F/TPSA,DRE and TURS results(p<0.05).Base on the variate,Loglstic regression model to assess the possibility of positive initial prostate biopsy was developed,the Loglstic regression model was logit P=-0.036�PV+10.457�F/TPSA-1.492�(F/T)/PSAD+1.618�DRE+1.427�TURS.?Conclusions? Using PSAD can improve the efficiency of PSA in diagnosis of prostate cancer and decrease the unnecessary prostatic biopsy in men with a PSA of 0~50,4~10 and 10~20 ng/ml.Our results indicate that PV?F/TPSA?(F/T)/PSAD ?DRE?TURS are independent predictors of a positive biopsy,and the risk of a positive initial prostate biopsy can be predicted in Loglstic regression model.Part II A case control study on the quality of life and Illness perception in males underwent transrectal ultrasound guided prostate biopsy?Objective? To explore the characteristics related to the quality of life,illness perception and depressive symptoms in males underwent transrectal ultrasound guided prostate biopsy,compared to males without prostate biopsy.?Methods? The case-control study was conducted,with secondary data analysis on 61 patients underwent transrectal ultrasound guided prostate biopsy and patients with BPH(control group).Patients were asked to complete the Brief Illness Perception Questionnaire(B-IPQ),the Self-Rating Depression Scale(SDS)and a Qo L item.Correlations and linear regression models were used to analyze the data.Student's t-tests were used to compare patients underwent transrectal ultrasound guided prostate biopsy with patients diagnosed with BPH.?Results? Of the 130 subjects included in our study,61 patients underwent transrectal ultrasound guided prostate biopsy and 36 patients with BPH completed the case-control study.There were no significant differences in age,smoking,marital status,household income,education grade between patients underwent transrectal ultrasound guided prostate biopsy and patients with BPH.Patients underwent transrectal ultrasound guided prostate biopsy reported a worse Qo L(5.30 � 1.51 vs 5.97 � 1.50,P=0.027),depressive scores(35.43 � 2.64 vs 32.42 � 2.71,P=0.001)compared to control.There were significant difference in consequence(6.31 � 1.64 vs 5.06 � 1.22,p=0.001),treatment control(5.05 � 1.13 vs 6.39 � 1.55,p=0.000),concern(5.61 � 1.23 vs 2.75 � 1.02,p=0.000),emotional representations(5.77 � 1.45 vs 4.36 � 1.20,p=0.000)factor,between transrectal ultrasound guided prostate biopsy and control group.Partial correlation analysis in patients underwent transrectal ultrasound guided prostate biopsy showed that the consequence closely related to identity,concern,personal control and emotional representations,personal control closely related to identity,concern.Partial correlation analysis in patients with BPH showed that the consequence closely related to identity,concern,personal control,treatmeat control and timeline,but no related to emotional representations.The items of illness perceptions,consequence(r=-0.604,P=000),personal control(r=-0.566,P=0.00)and concern(r=-0.557,P=0.000)were related to Qo L,and the items of illness perceptions,consequence(r=0.300,P=0.019),personal control(r=0.283,P=0.027)concern(r=0.373,P=0.003),and emotional representations(r=0.282,P=0.028)were related to depressive symptoms.?Conclusion? Patients underwent transrectal ultrasound guided prostate biopsy reported a decreased Qo L and increased depressive symptoms and illness perception,compared to patients with BPH.Illness perceptions and Qo L were associated with each other.Patients reported more strongly affected illness perceptions compared to people with BPH.The self-management intervention targeting patients' illness perceptions may lead to decreased Qo L and increased depressive symptoms.Part III The prospective study of the Quality-of-Life Outcomes and Illness perception of Patients undergoing Transrectal Prostate Biopsy?Objective? To evaluate whether transrectal ultrasound(TURS)guided prostate biopsy results in patient-reported quality-of-life(Qo L)changes from baseline in the first 3-month and 6-month after(TURS)guided prostate biopsy in a prospective,observational study.?Methods? Consenting patients completed the Brief Illness Questionnaire(B-IQP)the International Index of Erectile Function(IIEF-5),the International Prostate Symptom Score(IPSS),the Self-Rating Depression Scale(SDS),the Self-Rating Anxiety Scale(SAS),the Simplified Coping Style Questionnaire(SCQ)and a global question about quality of life.The published scoring methods were used in the instruments.The t-tests were used to investigate statistically significant differences.?Results? In all,98 patients consented to participate and 73 patients who fulfilled the inclusion criteria completed the baseline questionnaire,in addition to the 1-or 6-month follow-up questionnaires.At baseline,There were no significant di erences between patients with prostate cancer and patient with no-cancer in age,income,education level,marital state.We found that most patients having a TURS-guided prostate biopsy had significant change in Qo L,depressive symptoms,anxiety symptoms and illness perception scores in the first 1 and 3 months after URS-guided prostate biopsy.The Qo L scores S were significantly different at the 1-month(4.58 � 1.07,p=0.000)and the 6 month (4.53 � 1.17,p=0.000)compared to beseline(6.22+1.23).The depressive scores measured by the SAS were significantly different at the 1-month(40.36 � 5.58,p=0.000)and the 6 month(37.40 � 4.85,p=0.000)compared to beseline(34.58 � 3.79).The depressive scores measured by the SDS were significantly different at the 1-month(36.72 � 3.92,p=0.000)and the 6 month(39.16 � 5.75,p=0.000)compared to beseline(34.55 � 3.35).The IIEF-5 scores were significantly different at the 1-month(2.04 � 1.99,p=0.000)and the 6 month(2.45 � 2.27,p=0.000)compared to beseline(4.48 � 4.58).The IPSS scores were significantly different at the 1-month(9.47 � 3.87,p=0.000)but no significantly different the 6 month(6.87 � 3.87,p=0.526)compared to beseline(6.71 � 3.29).At baseline,the depressive and anxiety symptoms,Qo L,IIEF and illness perception had no significant differences between two cohorts.Subgroup analysis were conducted among men with 27 who had biopsy-proven PCa men and others who had no biopsy-proven PCa.There were significantly greater changes in their post-biopsy Qo L scores compared with men without(4.22 � 0.89 vs 4.78 � 1.11;P<0.001),post-biopsy IIEF scores compared with men without(1.37 � 1.32 vs 2.43 � 2.21;P<0.001),post-biopsy IPSS scores compared with men without(10.81 � 3.90 vs 8.67 � 3.66;P<0.001),post-biopsy SAS scores compared with men without(43.11 � 5.68 vs 38.74 � 4.89;P<0.001),post-biopsy SDS scores compared with men without(38.30 � 3.81 vs 35.80 � 3.72,P<0.001)at the first month.There were significantly greater changes in their post-biopsy Qo L scores compared with men without(3.78 � 0.80 vs 4.98 � 1.12;P<0.001),post-biopsy IIEF scores compared with men without(1.70 � 1.32 vs 2.93 � 2.59;P<0.001),post-biopsy SAS scores compared with men without(39.93 � 5.39 vs 35.91 � 3.83;P<0.001),post-biopsy SDS scores compared with men without(42.56+6.15 vs 37.17+4.48,P<0.001)but no significantly greater changes in post-biopsy IPSS scores compared with men without(10.81 � 3.90 vs 8.67 � 3.66;P<0.001),at the 6 month.The illness perception scores(included Identity,Consequences,Emotional representations,Timeline,and Concern)measured by the B-IPQ had significantly greater changes different at the 1-month compared to beseline.Subgroup analysis were conducted among men with biopsy-proven PCa and without in illness perception.Patients who were subsequently diagnosed with cancer based on the results of the TURS-guided prostate biopsy had statistically significantly increase in Identity,Consequences,Emotional representations,Timeline,and Concern dimension for the B-IPQ scales.Partial correlation analysis showed positive coping style the strongly negtaively associated with the anxiety symptoms at the 1-month(r=-0.513)and 6-month(-0.543),and depressive symptoms at the 1-month(r=-0.390)and 6-month(-0.475),but the strongly negtaively associated with the anxiety symptoms at the 1-month(r=0.318)and 6-month(0.327),and depressive symptoms at the 1-month(r=0.237)and 6-month(0.375)?The relationship between coping style and total quality of life,depressive and anxiety symptoms was partially mediated by illness perceptions.?Conclusion? Most patients having a TURS-guided prostate biopsy had significant change in Qo L,erectile function,depressive symptoms,anxiety symptoms and illness perception.in the first 1 and 6 months after TURS-guided prostate biopsy.Prostate Cancer diagnosis appears to have an adverse e ect on the Qo L,erectile function,depressive and anxiety symptoms and illness perception of men undergoing TURS-guided prostate biopsy but no e ect on LUTS.Our study highlights a potential negative psychological and illness perception confounder that may influence Qo L,erectile function,depressive and anxiety symptoms.