Clinical Characteristics and Cause of Missed Diagnosis of Prostate Cancer by Ultrasound-guided Transrectal Prostate Biopsy

FAN Lili; LAN Qiyu; MAO Lingling; GUO Gongying; DENG Hongmei; WU Hang

doi:10.3969/j.issn.1002-3429.2023.09.006

Abstract：Objective To investigate the clinical characteristics and causes of missed diagnosis of prostate cancer by ultrasound-guided transrectal prostate biopsy.Methods A total of 80 patients with suspected prostate cancer admitted from July 2021 to March 2023 were selected and divided into non-consistency group(n =31)and consistency group(n =49)ac-cording to consistency of the results of ultrasound-guided transrectal prostate biopsy and postoperative pathological examina-tion.The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to explore the influ-encing factors of missed prostate cancer by ultrasound-guided transrectal prostate biopsy.The nomogram prediction model of missed prostate cancer by ultrasound-guided transrectal prostate biopsy was constructed by R3.3.2 software and rms software package.Receiver operating characteristic(ROC)curve,calibration curve and clinical decision curve were used to evaluate the diagnostic efficiency of the predictive model.Results Age,prostate-specific antigen(PSA),PSA density(PSAD),proportion of positive direct rectal examination(DRE)results,proportion of positive transrectal ultrasound(TRUS)examina-tion results,and proportion of prostate imaging reporting and data system(PI-RADS)score≥4 were lower in the non-consistency group than in the consistency group,while the prostate volume(PV)was larger than that of the consistency group(P＜0.05,P＜0.01).Results of multivariate Logistic regression analysis showed that age,PSA,PV,DRE and PI-RADS score were independent risk factors for missed diagnosis of prostate cancer in ultrasound-guided transrectal prostate biopsy(P＜0.05,P＜0.01).The nomogram prediction model built based on risk factors predicted that the probability of missing prostate cancer by ultrasound-guided transrectal prostate biopsy was 82.00%,and the ROC curve showed that the area under the ROC curve was 0.836(95%CI 0.786,0.899),the sensitivity was 81.20%,and the specificity was 77.40%.Calibra-tion curve and clinical decision curve showed that the prediction model had high accuracy,effectiveness and clinical practica-bility.Conclusion Ultrasound-guided transrectal prostate biopsy has a high rate of missed diagnosis of prostate cancer.Age,PSA,PV,DRE and PI-RADS score are independent risk factors for missed diagnosis of prostate cancer.Therefore,the num-ber of biopsy samples of the above risk factors should be increased to reduce the risk of missed diagnosis of prostate cancer.