[Establishment and evaluation of a model for predicting ISUP pathological grade≥2 before radical prostatectomy]

Objective: Based on the 2014 version of the International Association of Urological Pathology (ISUP) pathological classification standards, a prediction model that can predict the pathological classification of ISUP ≥2 in patients with prostate cancer (PCa) before radical prostatectomy (RP) was established and evaluated. Methods: The clinical data of 171 patients who had undergone RP from January 2017 to September 2020 in the Second Affiliated Hospital of Soochow University and obtained postoperative pathological results of all specimens were retrospectively collected. The patients were 46-83 (70±7) years old. For patients with RP ISUP pathologic stage as the gold standard, according to the pathological grading is level 2 or higher is divided into two groups(42 patients with ISUP grade=1 and 129 patients with ISUP grade ≥2). the predictors of ISUP pathology grade ≥2 after RP were screened by logistics regression analysis, predictive models were established and ROC curves were used to evaluate the efficacy of each model in diagnosing RP with pathological grade ≥2, and comparisons were conducted by DeLong test. Results: Compared with patients with ISUP grade=1, patients with ISUP grade≥2 had higher prostate specific antigen (PSA) and prostate specific antigen density (PSAD) (14.21(8.57, 24.98)ng/ml vs 7.98(5.41, 12.54)ng/ml, 0.33(0.20, 0.74)μg.L^-1.ml^-1 vs 0.16(0.12, 0.24)μg.L^-1.ml^-1), lower prostate volume (PV) (48.62(34.17,73.99)ml vs 38.94(28.15,54.84)ml)(all P<0.05). Multi-parameter magnetic resonance imaging (mp-MRI) prostate imaging and reporting system (PI-RADS) score, the positive ratio of puncture needles and the pathological grade of puncture ISUP were also significantly different between the two groups (all P<0.05). The combined mp-MRI PI-RADS score (OR=3.337, 95%CI: 1.990-5.593, P<0.001) and puncture ISUP pathological grading (OR=4.041, 95%CI: 1.960-8.334, P<0.001) had the highest diagnostic efficacy for pathological grading ≥2 after RP (AUC=0.916, P<0.05). Conclusion: The combined mp-MRI PI-RADS score and puncture ISUP pathological grading had the highest diagnostic efficacy for pathological grading ≥2 after RP.