Effect Of Intravesical Prostate Protrusion Morphology On Prostate-specific Antigen

Objective(s):This study focused on exploring the effects of prostate morphological parameters on serum PSA levels in patients with benign prostatic hyperplasia(BPH)in practical clinical situations.To investigate the correlation of intravesical prostate morphological parameters(IPPP),conventional prostate morphological parameters(PMP),age with serum prostate-specific antigen(PSA)and prostate-specific antigen density(PSAD);the relationship between IPPP and PMP.To verify the difference in the distribution of PSA between different groups of patients with the degree of intravesical prostate protrusion,and to initially explore the distribution differences in the PSA grouped by the longitudinal diameter of the intravesical prostate protrusion.IPPP may be a predictive marker of prostate morphology for many factors that cause elevated PSA.This study conducted an exploratory analysis to study whether there were better predictive factors that cause serum PSA elevation in IPPP,whether there were independent influencing factors,and obtain the corresponding regression equation.Methods:A retrospective analysis of 201 patients diagnosed with benign prostatic hyperplasia by prostate tissue biopsy(surgery or ultrasound-guided prostate biopsy)in the Urology Department of our hospital from January 2020 to February 2022.Patients need to complete prostate magnetic resonance imaging(p MRI),and PSA value∈[4,20]ng/ml.Clinical data such as PSA,PSAD,age,pathological biopsy results,IPPP and PMP values under p MRI were collected.The correlation matrix was obtained by correlation analysis of IPPP、conventional PMP、age、PSA and PSAD.First,verify whether there was a difference in the distribution of PSA between the IPP significant group and the non-significant group.The longitudinal diameter was then divided into 3 groups.An exploratory study was conducted to determine whether there were differences in the distribution of PSA among groups with different longitudinal diameters.Multivariate linear regression was carried out between IPPP and PSA to preliminarily analyze whether there were factors in IPPP that can better predict the rise of PSA.Finally,IPPP and PSA were subjected to multivariate linear regression to analyze whether the three indicators could replace other factors to better predict PSA elevation,and under non-tumor factors the multivariate linear regression equation of IPPP for predicting elevated serum PSA in BPH patients was obtained.Results:A total of 201 patients with BPH were enrolled in this study.The test data of the whole group patients were not normally distributed.In the correlation analysis,1.PSA and IPPP parameters were positively correlated,among all IPPPs,There was no significant correlation between PMP and PSA.PSA was positively correlated with PSAD.2.IPP had a positive correlation with longitudinal diameter,PV and upper and lower diameters.There was no significant correlation between IPP and funnel morphology,lobation,left and right diameters,or anteroposterior diameters.3.The longitudinal diameter was positively correlated with PV、upper and lower diameters、left and right diameters and anteroposterior diameters.The longitudinal diameter showed no significant correlation in funnel status and leaf segmentation.4.Funnel morphology was positively correlated with lobation.Neither the funnel morphology nor the other morphological parameters were statistically significant.5 Age showed no significantly associated with all parameters.Difference analysis:1.The difference in the distribution of PSA between the IPP non-dominant group and the dominant group(Z=-5.986,p<0.001)was statistically significant.2.There were significant differences in PSA distribution among the three longitudinal diameter groups(H=50.381,p<0.001).Further comparison of differences between groups,the longitudinal diameter of group 1-2(H=-50.061,adjusted P<0.001)and group 1-3(H=-72.772,adjusted P<0.001)was statistically significant.There was no statistical difference between group 2 and group 3(H=-22.71,adjusted P>0.05).Multi-factor linear regression analysis:Multivariate linear regression was performed with PSA as the dependent variable and IPP,longitudinal diameter,and funnel shape as predictors.Statistical results:DW value=1.849.The VIFs of collinearity diagnosis of the three predictive parameters were all less than 5.The residuals are approximately normally distributed and have a reasonable variance.In the model,the P<0.05 of the predictive variable IPP,and the P<0.001 of the longitudinal diameter and funnel shape were statistically significant.The three factors were independent factors that predict the rise of serum PSA in BPH patients.After adjustment,the R~2was 0.420.The standardized bate values were 0.173,0.289,and 0.458.The resulting linear regression equation was:PSA=0.138*IPP+0.164*longitudinal diameter+4.468*X+4.044X value(funnel-shaped existence=0,funnel-shaped disappearance=1),PSA∈[4,20]ng/ml.Conclusion(s):1.IPPP is a positive correlation factor affecting low to moderate serum PSA levels in patients with benign prostatic hyperplasia,and the correlation is significantly stronger than conventional PMP and age.Only the longitudinal diameter was moderately positively correlated with the PSA in the IPPP.2.IPP and longitudinal diameter are morphological parameters of intravesical prostate that are positively correlated with conventional morphological parameters of the prostate.3.IPP is a significant positive factor affecting serum PSA level in patients with benign prostatic hyperplasia.The serum PSA level of patients with significant IPP group is significantly higher than that of non-significant IPP group.4.The longitudinal diameter of Intravesical prostatic protrusion is a significant positive factor affecting the serum PSA level in patients with benign prostatic hyperplasia.The PSA of BPH patients with intravesical prostatic protrusion>20mm is significantly higher than that of patients with the longitudinal diameter of intravesical prostatic protrusion≤20mm.5.IPPP does not cause PSA elevation entirely by itself,but through the joint action of its abnormal shape and structure,bladder dysfunction and many factors that increase PSA.From a statistical point of view,the 42%increase in serum PSA in BPH patients can be explained by the above three indicators and the underlying influencing factors.IPP,longitudinal diameter,and funnel shape in IPPP are all independent factors that can predict the rise of PSA.After normalization,the predictive power of the three parameters on PSA is as follows:disappearance of funnel>length of longitudinal diameter>length of IPP.The multiple linear regression equation is:PSA=0.138*IPP+0.164*longitudinal diameter+4.468*X+4.044 X value(funnel shape existence=0,funnel shape disappearance=1),PSA∈[4,20]ng/ml.