| ObjectiveTo evaluate the correlation between clinical parameters such as serum total prostate-specific antigen(tPSA),the related variables of tPSA,multiparametric magnetic imaging and prostate cancer and clinically significant prostate cancer in the diagnostic gray zone(4-10 ng/ml).To evaluate the diagnostic efficacy of each indicator for prostate cancer and clinically significant prostate cancer when tPSA is in the diagnostic gray zone,and further to guide prostate biopsy within PSA gray zone.At the same time,a multi-parameter model was established to predict prostate cancer and clinically significant prostate cancer.Meanwhile,evaluate the diagnostic efficacy of the model for prostate cancer and clinically significant prostate cancer,so as to reduce or avoid unnecessary biopsy of patients with tPSA in the diagnostic gray zone.MethodsWe retrospectively analyzed patients with prostate biopsy in a total of 1227 patients treated in our hospital from May 2014 to September 2018.And 242 patients whose total serum PSA were in the diagnostic gray zone.According to the results of transrectal ultrasound guided biopsy for prostate,the patients with tPSA in the diagnostic gray zone,were divided into group PCa,group non-PCa and group clinically significant PCa.Statistical means were used to analyze the age,tPSA,fPSA,(f/t)PSA,prostate volume,serum total prostate-specific antigen density(PSAD)as well as multiparametric magnetic imaging(mpMRI)including magnetic imagine resonance magnetic(MRI)and resonance spectroscopy(MRS)examination and other relevant data.To evaluate the diagnostic efficacy of each variable in prostate cancer(PCa)and clinically significant PCa(CSPCa)(Gleasson score?7)with tPSA in the diagnostic gray zone.Meanwhile,multivariate models were validated to predict PCa and CSPCa with PSA in the diagnostic gray zone.ResultsOf 242 patients with tPSA in the diagnostic gray zone,63 patients were positive,and the positive rate was 26.0%,(63/242).Positive biopsy results include 56 cases of adenocarcinoma,and the positive rate was 23.1%,3 cases of mucinous adenocarcinoma,and 4 cases of stromal sarcoma.Of the PCa cases,28 were with Gleason score?6,and 28 were with Gleason score?7.There were 179 cases with negative biopsy results,and the negative rate was 74.0%.There was no statistically significant difference in age,tPSA,fPSA,(f/t)PSA between group PCa and group non-PCa(P>0.05,0.052?0.824?0.633?0.764,respectively).Adversely,PSAD,prostate volume and mpMRI examination showed statistically significant difference(all the P value were less than 0.001).Univariate analysis showed that prostate volume,PSAD,and mpMRI examination as the independent risk factors were significant predictors of PCa as well as CSPCa.The differences of diagnostic accuracy between mpMRI examination(AUC=0.69)and other clinical parameters in diagnostic accuracy for PCa were not statistically significant.However,mpMRI examination(AUC=0.79)outperformed prostate volume and PSAD in diagnosis of CSPCa.At the same level of sensitivity as the mpMRI examination to diagnose PCa,applying the multivariate models could reduce the number of biopsies by 5%.And at the same level of specificity as the mpMRI examination to diagnose PCa,applying the multivariate models could add the positive prostate biopsy rate by 3%.Conclusions1 In this study,as independent risk factors,the prostate volume,PSAD and mpMRI examination play great role in diagnosing PCa and CSPCa with PSA in the diagnostic gray zone.And the three factors are significant references in the diagnosis of PCa as well as CSPCa.Compared with PSAD and prostate volume,the diagnostic efficacy of mpMRI in PCa and in CSPCa with tPSA in the diagnostic gray zone is more obvious.2 The multiparametric model could be used as an aid to identify PCa and CSPCa among men with tPSA in the diagnostic gray zone and to reduce unnecessary biopsies without compromising the ability to diagnose PCa and CSPCa with PSA in the diagnostic gray zone. |
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