Materials and Methods
The data of the patients who received transrectal ultrasound guided (TRUS) biopsies due to high PSA levels or suspicious findings during DRE were evaluated retrospectively between March 2017 and August 2020. We included all the patients (78 patients) who had PSA levels between 2.5-10 ng/ml and adenocarcinoma of the prostate on TRUS biopsies. We excluded patients who had PSA levels < 2.5 or >10 and patients who have PSA levels between 2.5-10 ng/ml with benign conditions, ASAP (atypical small acinar proliferation), HGPIN (high-grade prostatic intraepitelial neoplasia), and prostatic malignancy other than adenocarcinoma. In addition to the demographic data of the patients, PSA, free PSA, prostate volume (based on TRUS), DRE findings, and prostate biopsy pathology reports were recorded. Our primary endpoint was to assess the associations of PSAD and f/t PSA with CSPCa. CSPCa was defined as Gleason ≥7. Our secondary endpoints were to assess the associations of PSA, free PSA, prostate volume with CSPCa and the associations of PSA, free PSA, PSAD, f/t PSA, and prostate volume with Gleason subgroups. We used the International Society of Urological Pathology (ISUP) grading for Gleason subgroups (10) (Table 1). All patients underwent TRUS biopsies in the lateral decubitus position with periprostatic prilocaine block. An 18-gauge automatic disposable needle was used in each case.
Statistical analysis of the data was carried out using the IBM Statistical Package for Social Sciences (SPSS) 20 program on the computer. The suitability of the variables to normal distribution was examined with the Shapiro Wilk Test. The Mann-Whitney U test was used to compare continuous outcome variables in two groups; one-way analysis of variance (ANOVA) and Kruskal Wallis-H tests were used in three or more groups. Post-hoc Tukey-HSD, LSD, and Tamhane’s T2 were used in groups showing normal distribution, and post-hoc Mann-Whitney U test was used in groups that did not show normal distribution for multiple comparison. The significance level was accepted as p <0.05. Two receiver operating characteristic (ROC) curves were drawn to obtain the best PSA and PSA density cutoff value for CSPCa.
Approval was obtained from the Ethical Board of Trabzon Kanuni Training and Research Hospital for this retrospective study.