Analysis Of Predictive Factors And Establishment Of Predictive Model For Positive Repeated Prostate Biopsy

Objective:It is often found in clinical work that some patients with abnormal prostate-specific antigen(PSA)who have negative pathological results on the first prostate biopsy can still be detected by repeated puncture.In this study,we analyzed the risk factors of pathological results of repeated prostate biopsy,explored the predictive value of PSA and other prostate-related parameters in the pathological results of repeated prostate biopsy,and established a prediction model to provide a reliable basis for clinical decision-making on whether to perform repeated biopsy.Methods:The clinical data of 104 patients who underwent repeated needle biopsy due to negative first prostate biopsy from January 2016 to January 2021 in our hospital were retrospectively analyzed;they were divided into PCa non-PCa group according to whether the pathological results of repeated needle biopsy were prostate cancer(PCa)or not.SPSS 26.0 software was used to statistically analyze whether there were statistical differences in age,body mass index(BMI),serum total PSA(tPSA),free to total prostate-specific antigen ratio(f/tPSA),prostate volume(PV),prostate-specific antigen density(PSAD),digital rectal examination(DRE),transrectal color Doppler ultrasonography(TRUS),PI-RADS score and pathological results of the first needle biopsy between the two groups,so as to obtain the risk factors affecting the pathological results of repeated needle biopsy,and multivariate analysis was performed to screen out the independent predictors.Finally,independent predictors were included in R software to establish a Nomogram prediction model for the pathological results of repeated needle biopsies.Results:A total of 104 patients who underwent repeated needle biopsy were included in this study,the positive rate of repeated needle biopsy was about 35.58%,and the pathological results were PCa in a total of 37 cases,including 26 cases of clinically significant prostate cancer(csPCa)(Gleason score ≥ 7 points),11 cases of clinically insignificant prostate cancer(Gleason score < 7 points),and 67 cases of pathological results of non-PCa(with or without prostatitis),including 27 cases of benign prostatic hyperplasia(BPH),9 cases of high-grade intraepithelial neoplasia(HGPIN),3 cases of atypical small acinar hyperplasia(ASAP),3 cases of non-specific granulomatous inflammation,1 case of tuberculosis,and 24 cases of normal prostate tissue.The results of statistical analysis showed that tPSA(AUC: 0.789,P < 0.01)was the best independent predictor of PCa detection by repeated prostate biopsy,while the predictive power of PSAD(AUC: 0.757,P < 0.01)and PI-RADS score(AUC: 0.675,P < 0.01)was relatively weak.Both PSAD and PI-RADS scores were independent predictors of csPCa detection in repeated needle biopsies.The AUC of the Nomogram model including three variables: tPSA,PSAD,and PI-RADS scores was 0.842,with high predictive power.Conclusion:1、Through the analysis of this study,it is found that tPSA,PSAD,and PI-RADS scores are independent predictors of prostate cancer detected by repeated biopsy,while factors such as age,BMI,f/tPSA,PV,DRE,TRUS,and pathology of the first biopsy are related to each other.Pathological results of repeated biopsy are irrelevant.2、Regarding the detection of csPCa by repeated needle biopsy,only PSAD and PI-RADS scores have an independent predictive effect.3、The Nomogram model that incorporates three independent predictors of tPSA,PSAD and PI-RADS scores has a high predictive power for positive repeated biopsy,and the predicted results are less different from the actual results,which can guide clinical decision-making well and reduce a lot Needless needle biopsy.