Joint Classification By Transrectal Ultrasound Guided Biopsy And Prostatic Specific Antigen To Predict Prostatic Carcinoma

Background:Accurate predicting of pathological stage of prostatic carcinoma before radical operation is meaningful to choose therapy, estimate effecti.veness and evaluate prognosis.The common methods to predict prostatic carcinoma stage include digital exami.nation of rectum, prostatic specific antigen(PSA),prostatic acid phosphatase(PAP), systemic biopsy(Gleason grade),spermatophore biopsy,all.kinds of imaging examinations and pelvic lymphoma resection.However,the accuracy and specificity of any single method are discussable.In order to do better pre-operation analysis and proposal,it is necessary to combination of these:methods to more accurately predict prostatic carcinoma stage.Combination of 3-dimensional ultrasonography,serum PSA,ultrasonic guided biopsy,and Gleason grade to predict prostatic carcinoma stage is clinically significant.Purpose:The purpose of this study is to evaluate clinical value of combing serum PSA,ultrasonic guided biopsy and Gleason grade to predict pathological stage of prostati.c carcinoma.To investigate method of combing serum PSA to predict prostatic carcinoma stage.Subjects and methods:97 patients with.prostate disease who came to our hospital between January 2007 and Apri.l 2009 were enrolled.Some of these patients had symptoms of frequent micturition,urgent micturition and urodynia.Some came to our hospital because of healthy examination. All of these patients had.prostatic carcinoma which was confirmed by ultrasonic guided biopsy and post-operation pathological examination. Firstly,trans-abdominal and trans-rectal examination was done using VV 7 color 3D/4D digital ultrasound system to observe the size and capsule of prostate,the location and.size of mass,the relationship of the mass and prostatic capsule,to measure the volume of entire prostate,inner gland and the mass.Gleason system(GS) and Jewett-Whitmore-Prout system were used to classify and stage prostatic carcinoma respectively.Preoperation serum PSA was detected using radio-immune method.Transrectal biopsy through 6 points was performed to obtain biopsy Gleason grade.Pathological classification and staging were carried out according to the post-operation histological modality and clinical data.Rank correlation analysis,rank test and multifactor analysis were used to analyze the relationship between serum PSA,Gleason grade and staging of prostatic carcinoma.Results:The higher of serum PSA,the higher of GS;the advancing of stage,the higher of PSA and GS.PSA in groups of GS 2～5,6～7 and 8～10,between groups of GS 2～5 and GS 6～7,GS 2～5 and GS 8～10 had statistic differences,whereas PAS between group GS 6～7 and GS 8～10 had no difference.The percentage of locating within 95%confidence interval of stage A or B were 44%—73%when PSA≤20ug/L, whereas the percentage of locating within 95%confidence interval of stage C or D were 68%—88%when.PSA＞20ug/L.The 95%confidence interval of stage A or B was 53%～89%,27%～56%,2%～28% in group GS 2～5,GS 6～7,and GS 8～10 respectively.Applying stage related PSA and GS into equation X=-3.501+0.039×PSA+0.403×GS indicated that the stage may be C or D if X＞0,A or B if X＜0.Conclusion:Serum PSA was positively conrrelated with GS.Serum PSA and GS were positively correlated with stage in prostatic carcinoma respectively.PSA/volum of prostate was negatively correlated with stage when PSA≤10ug/L.The equation X=-3.501+0.039×PSA+0.403×GS could predict prostatic carcinoma stage.