The Predictive Value Of Serum PSA Series In Prostate Biopsy And Gleason Score

ObjectiveTo explore the predictive value of serum PSA series in prostate biopsy and Gleason score,and to provide theoretical basis for clinical precise prostate biopsy and guiding treatment.Methods?1?Detailed clinical data of 532 patients admitted to the urology department of ningxia medical hospital for TRUSGB surgery from March 2014 to August 2018 were collected,including age,serum PSA series indicators,prostate volume,pathological results after puncture.Patients were divided into four groups according to the total PSA values:group A?tPSA?4ng/ml?,group B?tPSA4¹0ng/ml?,group C?tPSA10²0ng/ml?,and group D?tPSA>20ng/ml?.The positive rate of puncture in each group was analyzed and compared.The tPSA in4¹0ng/ml and 10²0ng/ml intervals were mainly discussed,Whether tPSA,PSAD,f/tPSA,?f/tPSA?/PSAD are statistically different between the PCa group and the n-PCa group In the above two intervals.ROC curve analysis was used to compare the best clinical reference values of the above indicators in prostate biopsy,so as to evaluate their efficacy in early diagnosis of PCa.?2?According to the results of biopsy,122 men with PCa?tPSA<100ng/ml?were divided into two groups according to Gleason score:low and medium risk?Gleason score?7?and high risk?Gleason score>7?,Compare and analyze whether there are statistical differences in age,tPSA,f/tPSA,PSAD,?f/tPSA?/PSAD between different groups and whether there are correlations with Gleason score.ResultsThe positive rate of biopsy in group A,group B,group C and group D was9.6%?3/31?,12.5%?14/112?,21.4%?36/168?and 66.5%?147/221?,respectively,showing an increasing trend(?²_trend=92.778,p<0.001).The average positive rate was 37.6%?200/532?.In groups B and C,f/tPSA,PSAD and?f/tPSA?/PSAD showed statistical difference between the PCa group and the n-PCa group?p<0.05?,while tPSA showed no statistical difference?p>0.05?.In group B,the area under the ROC curve?AUC?was?f/tPSA?/PSAD?0.753?>PSAD?0.727?>f/tPSA?0.677?>tPSA?0.622?.When tPSA>7.175ng/ml,f/tPSA<0.172,PSAD>0.192,?f/tPSA?/PSAD<0.719,they have good sensitivity and specificity.The corresponding accuracy of prostate biopsy is 58.04%,62.50%,67.85%,72.32%,The rates of avoiding prostate biopsy were 50.89%,53.57%,58.92%and 61.60%,respectively.In group C,the AUC was?f/tPSA?/PSAD?0.767?>PSAD?0.704?>f/tPSA?0.670?>tPSA?0.584?.When tPSA>13.51ng/ml,f/tPSA<0.143,PSAD>0.281,?f/tPSA?/PSAD<0.608,it had good sensitivity and specificity.The corresponding accuracy of prostate biopsy was 47.02%,60.12%,66.66%,69.04%,and the rates of avoiding prostate biopsy were 33.33%,46.42%,50.00%and 51.19%,?2?There were statistically significant differences in tPSA,PSAD,?f/tPSA?/PSAD between the middle-low and high risk groups?P<0.05?,but no statistically significant differences in age and f/tPSA?P>0.05?.Spearman analysis showed that tPSA and PSAD were positively correlated with Gleason score?r=0.423,P<0.001;r=0.391,P<0.001?,?f/tPSA?/PSAD were negatively correlated with Gleason score?r=-0.344,P<0.001?,while age,f/tPSA were not correlated with Gleason score?P>0.05?.Conclusion1.When serum tPSA>20ng/ml was detected in elderly male patients,the positive rate of prostate biopsy increased with the increase of tPSA.2.When tPSA is between 4²0ng/ml,the positive rate of prostate biopsy is relatively low.The combination of f/tPSA,PSAD and?f/tPSA?/PSAD can significantly improve the positive rate,among which?f/tPSA?/PSAD has a high predictive value.3.tPSA,PSAD and?f/tPSA?/PSAD have predictive value for Gleason score,which can provide important reference for the later diagnosis and treatment plan.