| ObjectiveSummarize the experience in trans-rectal ultrasound-guided 12+X-core biopsy and analyze the influencing factors of the biopsy results,and determine the diagnostic value of mp-MRI for the detection of prostate cancer.MethodsTotally,patients who had a trans-rectal ultrasonography(TRUS)-guided 12+X-core biopsy were retrospectively analyzed in the study between Jan.2010 and Mar.2016.Patient demographics(PSA,PSAD,age,weight,MP-MRI and prostate volume)and MP-MRI findings were collected and assessed by the statistical package for an association with prostate cancer detection on biopsy.Every core positive rate,lateral zone and contralateral zone positive rate were analyzed.The biopsy positive rates were also analyzed,adjusted to the age and PSA.The complications were analyzed.The Logistic regression analysis was used for data analysis.Statistical comparisons of categorical and continuous variables were performed using Chi-square test/Mc Namara's test and paired,two-tailed Student's t-tests,respectively.For the detection of prostate cancer,we used receiver operating characteristic(ROC)curves to assess the discriminative ability of pre-biopsy variables.We used binormial parametric estimation method to calculate the area under the curve(AUC)for each ROC curve by SPSS.ResultsAmong the 622 patients who underwent 12+X-core prostate biopsy,the pathological result include BPH(314),PIN(31),doubtful-Pca(26)and Pca(231).The positive biopsy rate was 37.1%(231/622).The contralateral zone and lateral zone positive rate is 21.6%(807/3735)and 21.3%(796/3736)(P>0.05),respectively.the positive rate of 1-12 core is 21.6±1.6%(P > 0.05)and the positive rate of X core is 34.8%(P <0.05).Subgroup analysis were conducted to evaluate the positive rate according to different factors: age?60y(26.7%),age 61-70y(32%),age 71-80y(45%),age>80y(64.0%)(P<0.05);Prostate specific antigen(PSA)<4 ng/ml(4.5%),4?PSA <10ng/ml(29.2%),10?PSA<20ng/ml(31.3%),20?PSA<40ng/ml(15.2%),40?PSA<60ng/ml(5.5%),60?PSA<80ng/ml(2.9%),80?PSA<100ng/ml(10.3%),PSA ?100 ng/ml(0.8%)(P<0.05).According to those indexes,we derived a series of formulas(A and B)for detection of Pca with optimized thresholds.For formula A: PSA+0.9×Age+ 0.2×Weight-0.5×Volume>72.For formula B: 32×PSAD+Age+0.5×Weight+33× MRI-0.3×Volume>166.Composite formulas have great capacity for the detection of Pca with area under the curve(AUC)of 0.88 and 0.93,respectively(compared with 0.78 and 0.75 for PSA level and PSAD,respectively).In addition,composite formulas also achieved significantly better ability to detect higher biopsy Gleason score(?7)than PSA and PSAD alone(AUC: 0.87 and 0.83 VS 0.71 and 0.73,respectively),P<0.001.ConclusionsThe age and serum PSA are both related to the positive rate of prostate biopsy and can be used as a prediction to guide the prostate biopsy.The combination of sextant and lateral peripheral zone biopsies(12+X biopsy scheme)have an advantage over 6 systematic biopsy and saturate biopsy scheme.The integrated formulas B is superior to PSA alone for the detection of prostate cancer. |
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