Establishing a Novel Prediction Model for Improving the Positive Rate of Prostate Biopsy

Tao Tao; Deyun Shen; Lei Yuan; Ailiang Zeng; Kaiguo Xia; Bin Li; Qingyu Ge; Jun Xiao


Transl Androl Urol. 2020;9(2):574-582. 

In This Article



This retrospective analysis included data from 237 patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy at the Department of Urology at the First Affiliated Hospital of the University of Science and Technology of China between July 2017 and March 2018. The inclusion criteria of the patients were as follows: (I) a prostate nodule as identified by DRE, or the suspicion of PCa from imaging examination (B-ultrasound or MRI); (II) PSA 4–10 ng/mL, f/t PSA <0.16; (III) PSA >10 ng/mL; (IV) complete clinical information. The exclusion criteria were as follows: (I) abnormal coagulation function; (II) abnormal white blood cell number in blood examination; abnormal urine routine indicating urinary system infection or acute prostatitis; (III) serious cardiopulmonary diseases; (IV) severe internal and external hemorrhoids and perianal or rectal lesions; (V) incomplete clinical information.

All patients enrolled had undergone PI with mpMRI (3.0T Magnetom Trio MR, Siemens) before the biopsy. All patients' laboratory data were obtained within 1 week before the biopsy. Every patient enrolled had a PSA assessment, routine blood test, biochemical examination, and DRE. In addition, the following information was gathered: age, gender, body mass index (BMI), PV (measured by mpMRI), biopsy Gleason sum score (BGSS), PI-RADS v2 score, hypertension, and DM history. All laboratory and imaging examinations were carried out in the hospital, with each being conducted by a specialized professional doctor, and with pathological specimens being diagnosed by two experienced pathologists.

Prostate biopsy was guided by a TRUS biplane imaging scan (Flex Focus 800, BK Medical) with the help of mpMRI cognitive fusion. Typically, the patients underwent systematic 12 + X-cores biopsy, which was based on 12-point systematic biopsy, with needles being applied to the suspicious lesions (the target was defined as X). The biopsy instruments used were the automatic biopsy gun and one-time 18G puncture biopsy needles (MCA18/20, GALLINI S.R.L.).

The NLR was calculated as the absolute neutrophil count divided by the absolute count of leukocytes. PSA density (PSAD) refers to the ratio of serum PSA concentration to PV. Diabetes and hypertension in patients were both diagnosed by endocrinologists and cardiovascular specialists. According to the probability of PCa, PI-RADS v2 scores represented the following: PI-RADS 1: very low, clinically significant cancer is highly unlikely to be present; PI-RADS 2: low, clinically significant cancer is unlikely to be present; PI-RADS 3: intermediate, the presence of clinically significant cancer is equivocal; PI-RADS 4: high, clinically significant cancer is likely to be present; PI-RADS 5: very high, clinically significant cancer is highly likely to be present.[17]

Statistical Analyses

The data were expressed as number (percentage), range, and median [interquartile range (IQR)]. All statistical analyses involved the use of SPSS v.22.0 (SPSS Inc., Chicago, IL, USA). P<0.05 was considered statistically significant. Univariate and multivariate logistic analysis was used to screen factors to select the statistically significant factors, and the association between these predictors and biopsy results was then tested. We examined the significant factors in logistic regression analysis, and thereafter, the significant factors' weight indexes were included in the screening formulas. Receiver operating characteristic (ROC) curves were used to assess the discriminative ability of the variables and formulas. The maximum sensitivity and specificity of the formulas were used to determine the best threshold, while 95% confidence intervals (95% CI) of the odds ratio (OR) were used as a measure to assess relative risk.