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.