Objective To investigate the influencing factors in diagnosis of prostate cancer by performing prostate puncture biopsy in patients with prostate specific antigen (PSA) in gray area.

Methods The medical records of patients undergoing transrectal ultrasound-guided prostate biopsy in Jiangsu North Hospital Affiliated to Yangzhou University from January 2020 to February 2022 were retrospectively collected. According to the inclusion and exclusion criteria, a total of 221 patients were included in the study, including 148 patients with negative puncture results and 73 patients with prostate cancer, with the detection rate of 33.03%. Univariate and multivariate analysis were performed for age, the free PSA to total PSA ratio (f/t PSA), prostate volume, PSAD and other parameters to explore the independent influencing factors of prostate cancer.

Results Univariate analysis showed that there were statistically significant differences in age, PSAD, f/t PSA, nuclear magnetic examination and prostate volume in prostate cancer patients when compared with those of negative results. Binary Logistic regression analysis showed that age, PSAD and prostate MRI were independent influencing factors for prostate cancer (P < 0.05), but there was no significant difference in prostate volume and f/t PSA (P>0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the curves of age, PSAD, prostate MRI, age combined with PSAD, age combined with prostate MRI, PSAD combined with prostate MRI, and age combined with PSAD as well as prostate MRI were 0.619, 0.806, 0.653, 0.804, 0.709, 0.831 and 0.843, respectively.

Conclusion For patients with PSA in gray area who underwent puncture biopsy of prostate gland, the independent risk factors for prostate cancer diagnosis are age, PSAD and prostate MRI, among which PSAD has higher value in diagnosis. Age combined with PSAD as well as prostate MRI is more helpful to guide the clinical need for further prostate biopsy.