The Study On The Relationship Between ADC,PSA Combined With Gleason Score And Bone Metastasis Of Prostate Cancer

Objective: To identify the independent influencing factors of bone metastasis of prostate cancer by analyzing the correlation between apparent diffusion coefficient(ADC)and bone metastasis of prostate cancer,so as to provide reference for clinical screening of patients with high risk of bone metastasis.Methods: A total of 147 patients with prostate cancer confirmed by pathology in our hospital from October 2017 to October 2019 were collected and divided into bone metastasis group and non-bone metastasis group according to the diagnostic criteria of bone metastasis.Univariate and multivariate Logistic regression analysis was used to determine the correlation between tumor tissue minimum ADC value(ADCmin),average ADC value(ADCmean),PSA,Gleason score,serum ferritin,alkaline phosphatase(ALP),age and other factors with bone metastasis of prostate cancer,and to determine the independent influencing factors of bone metastasis,and the receiver working characteristic curve(ROC)to analyze the value of single and combined application of the above indexes in predicting bone metastasis of prostate cancer.Results: A total of 147 patients with prostate cancer and 80 patients with bone metastasis were included in this study(54.4%).Among them,65 cases(81.25%)had vertebral metastases,55 cases(68.75%)had pelvic metastases,45 cases(56.25%)had sternal metastases,11 cases(13.75%)had skull metastases,and 31 cases(38.75%)had bone metastases in extremities.Among the 80 patients with bone metastasis,17 patients(21.25%)had mild bone metastasis,29 patients(36.25%)had moderate bone metastasis,and 34 patients(42.5%)had severe bone metastasis.Among the 17 patients with mild bone metastasis,5 patients had single bone metastasis.Through the comparison between groups,the ADCmin and ADCmean of patients with bone metastasis were lower than those of patients with non-bone metastasis,and the difference was statistically significant(P<0.05).The scores of ALP,PSA,Gleason and T stage in patients with bone metastasis were significantly higher than those in patients with non-bone metastasis(P < 0.05).Univariate analysis showed that ADCmin,ADCmean,PSA,Gleason score,ALP and clinical T stage were associated with bone metastasis of prostate cancer.Multivariate Logistic regression analysis showed that,ADCmin(OR: 0.867)was an independent protective factor for bone metastasis,while Gleason score(OR: 3.828)and PSA(OR: 1.021)were independent risk factors for bone metastasis.ROC curve analysis shows that the areas under the curve of ADCmin,Gleason score and PSA are 0.827,0.794 and 0.765 respectively,and the cutoff values are 0.81×10-3mm2/s(sensitivity: 89.2%,specificity: 71.3%),7.5points(sensitivity:76.5%,specificity:73.0%),69.8ng/ml(sensitivity:64.7%,specificit y: 73.0%);The area under the curve of prostate cancer bone metastasis diagnosed by multivariate Logistic regression equation was 0.937 by fitting the three independent influencing factors of dependent variables to: Y(joint index)= 1.342×Gleason score-0.143×ADCmin+0.021×PSA-6.56.The diagnostic value was higher than that of ADCmin,Gleason score and PSA.Conclusion: ADCmin is an independent protective factor for bone metastasis of prostate cancer,while PSA and Gleason scores are independent risk factors for bone metastasis of prostate cancer.Combined with the above indexes,a better predictive effect can be obtained.When ADCmin≤0.81×10-3mm2/s,PSA≥69.8ng/ml or GS score≥7.5,the risk of bone metastasis of prostate cancer is higher,even if the bone scan is negative,the MRI or PET/CT examination of the spine should be further improved to avoid delay in treatment.