| Objective To evaluate the value of prostate specific antigen density(PSAD)and risk stratification calculated by magnetic resonance imaging(MRI)in patients with low-grade Gleason score(GS)and biopsy of low-risk prostate cancer,and to predict the practicability of increase in Gleason score.Methods The clinical data of prostate cancer patients with pathological diagnosis in our hospital from 2016 to 2018 were analyzed retrospectively.The age of patients at that time,preoperative prostate specific antigen(PSA)value,puncture pathological results,magnetic resonance imaging data,prostate volume measured by MRI and PSAD and Gleason scores calculated by MRI were calculated.According to the consistency of preoperative transrectal ultrasound TRUS guided biopsy and radical prostatectomy biopsy GS,240 patients were divided into two groups: group A had the same Gleason score as postoperative Gleason score(GS 6 / ? 7)and group B had higher postoperative Gleason score(GS 6 / ? 7).PSAD,prostate volume,prostate specific antigen(PSA)and age were compared between the two groups based on magnetic resonance imaging,and logical regression and ROC analysis were performed.Results(1)compared with the general age of the two groups,the average age of all the 240 patients included in this study was 64.96 ±5.27 years old.There was no significant difference in age between the two groups by t-test of independent samples(P = 0.33).(2)comparison of PSA,PSAD and prostate volume between the two groups: the average PSA of all patients was 10.79 ±3.44ng/ml.The average prostate volume measured by MRI was62.13 ±6.53cm3,and the average PSAD calculated based on magnetic resonance imaging was 0.14 ±0.06ng/ml/cm3.The average PSA and PSAD of group B(13.20 ±3.00ng/ml and0.22 ±0.05ng/ml/cm3)were higher than those of group A(8.17 ±1.33ng/ml and 0.13 ±0.03ng/ml/cm3,respectively).There was significant difference between the two groups(P ?0.001).The average prostate volume measured by MRI in group B(60.85 ±5.98cm3)was less than that in group A(63.53 ±6.84cm3),there was significant difference between the two groups(P = 0.002).(3)ROC curve analysis showed that PSAD was the best predictor of GS elevation with an AUC of 0.939 although there was no significant difference between PSA and PSAD in the paired comparison of ROC curves(P = 0.27).The AUC value of PSAD was significantly higher than that of prostate volume(P = 0.03).There was no significant difference in AUC between PSA and prostate volume(P = 0.35).In ROC curve analysis,the cutoff values that provide the best sensitivity and specificity for PSAD,PSA and prostate volume are 0.26ng/ml/cm3,7.63ng/ml and 25.1cm3,respectively.Under these thresholds,the sensitivity and specificity of PSAD and PSA in predicting GS upgrades were 84.9% and 62.5%,and 81.8% and 65%,respectively.Conclusion(1)this study showed that the age of the patients had no significant effect on the increase of Gleason score and(GS)after radical prostatectomy(RP).(2)this study showed that serum PSA level,prostate volume and PSAD calculated based on MRI were statistically significant in group An and B,and were positively correlated with the increase of Gleason score(GS)after radical prostatectomy.Therefore,they can be regarded as predictors of the increase of GS after RP.(3)this study shows that PSAD has high sensitivity and specificity as a sensitivity and specificity for predicting the upgrading of GS.It is considered that PSAD can be used as an important clinical index of prostate cancer in order to guide the treatment of prostate cancer and judge the prognosis of prostate cancer.Therefore,PSAD based on magnetic resonance imaging can help to predict the increase of postoperative GS in patients with low-risk prostate cancer,which may reduce unnecessary follow-up biopsies in patients with low-risk prostate cancer and avoid adding unnecessary pain to the patient. |
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