Preliminary study on the relationship between chronic inflammation and biopsy results in prostate biopsy / 中华泌尿外科杂志

ABSTRACT

Objective:To investigate the correlation between chronic inflammation and biopsy results in the first prostate biopsy and the predictive effect of chronic inflammation on the results of repeated prostate biopsy.Method:From January 2016 to January 2019, 771 patients who underwent transperineal prostate biopsy for the first time in the Second Hospital of Tianjin Medical University were included. The average age was 69.6 years old(39-89), with PSA level of 16.1 ng/ml(4-50), PSAD level of 0.6 ng/ml 2(0.1-1.3), prostate volume(PV)of 40.2 ml(16.7-129.5), transition zone volume(TZ) of 23.9 ml(0.7-49.5). The biopsy was performed under general anesthesia in the lithotomy position, and transrectal ultrasound(TRUS)and prostate puncture template were used to guide the biopsy. The association between chronic inflammation and pathological results or Gleason scores in prostate cancer (PCa) were analyzed. The univariate and multivariate logistic regression analyses were performed to select the independent risk factors for prostate biopsy results. The relationship between chronic inflammation and pathological results in patients with repeated biopsy within 3 years after the first biopsy was assessed. The independent risk factors related to the results of the repeated biopsy were also evaluated. Result:A total of 771 patients were included, including 354 cases of PCa and 144(40.7%) cases associated with chronic inflammation. In addition, 332 cases were benign prostatic disease (BPD), including 263(79.2%) cases with chronic inflammation, and 85 cases were prostate high-grade intraepithelial neoplasia group (HGPIN), including 13(15.3%) cases with chronic inflammation. The PV, TZ and chronic inflammation rates were statistically significantly lower in PCa and HGPIN than those in BPD, while the level of PSA and PSAD were significantly higher than those in BPD. Multivariate logistics regression analysis showed that PSAD and chronic inflammation rates were independent risk factors for PCa and HGPIN. According to the biopsy results of Gleason score from 6 to 10, the chronic inflammation rates was 70%(35/50), 61%(36/59), 33%(69/209), 12%(3/25) and 9%(1/11) respectively ( P<0.05), which indicated that the chronic inflammation was negatively correlated with higher grade tumors. The repeated biopsy was performed in 30 patients within 3 years after the first biopsy. The average age was 71.2 years old (45-80), with PSA level of 20.1 ng/ml (4-39), PSAD level of 0.7 ng/ml 2(0.2-1.3), PV of 39.3 ml(18.5-119.0), and TZ of 19.9 ml(12.5-40.5). The results of the repeated biopsy showed that there were 9 cases with PCa(3 cases with chronic inflammation)and 21 cases without PCa (16 cases with chronic inflammation). The level of PSA ( P=0.031) and PSAD ( P=0.032) were statistically significantly higher in PCa than those in benign disease, while the chronic inflammation rates were significantly lower than those in benign disease( P=0.042). Multivariate logistics regression analysis showed that PSAD ( OR=0.7, P=0.012) and chronic inflammation( OR=13.7, P<0.001)were independent risk factors in the positive repeated biopsy. In patients with repeated biopsy, considering PSAD (cut off value 0.15) and first biopsy with chronic inflammation, the predicted results were positive in 8 cases and negative in 22 cases. The real number of cases in the two groups is 6 and 19 respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of repeated biopsy results were 66.7%, 90.4%, 75.0%, and 86.3%, respectively. Conclusion:Chronic inflammation was negatively correlated with positive biopsy results and high-grade tumors. For the patients with PSAD<0.15 and the first biopsy with chronic inflammation, the repeated biopsy should be avoided in most of the cases.