Predictive value of neutrophil-to-lymphocyte ratio in diagnosis of early prostate cancer among men who underwent Robotic transperineal prostate biopsy
Abstract Background NLR is known to have prognostic value for metastatic prostate cancer (PCa). However for early PCa due to lack of systemic response; the role of NLR is not conclusive. In this study we aim to evaluate the predictive value of NLR for early clinical PCa in patients who underwent robotic transperineal prostate biopsy (RTPB). Methods Patients who underwent RTPB under general anesthesia (GA), at the Department of Urology, Singapore General Hospital between Sep 2006 and Feb 2016 were retrospectively reviewed. Exclusion criteria includes: 1. Patients with missing value of PSA NLR 2. Patients who underwent biopsy for non-diagnostic purposes. 3. Patients with chronic inflammation or high grade prostatic intraepithelial neoplasia. Patients who had more than one biopsies and only the last histology results were included in this study. NLR was calculated for all patients using Complete blood count that was done as pre-admission test before GA within 4 weeks before operation. NLR values were compared between PCa; clinical significant PCa and benign group. Patients were divided further into different groups according to PSA level for subgroup analysis. Results A total 652 patients who underwent RTPB for diagnostic purpose with valid pre-procedure PSA level were included in this study. There were total 409 (62.7%) benign histology and 243 (37.3%) PCa cases. Median NLR in the benign histology group and PCa group were 2.00 and 1.99. There was no statistically significant (P=0.29). In the subgroups analysis, there were also no significant difference of median NLR value in clinical significant cancer group (defined as Gleason 3 + 4 and above) when compared to benign group (NLR 2.00 vs. 2.01, P=0.41) as well as in prostate cancer group and benign group according to different pre-biopsy PSA levels (PSA < 4, 4-10, 10-20 and > 20 ug/L), respectively. (P>0.05). NLR is not a significant predictor for Gleason grade group and D’Amico risk stratification group. (P>0.05) Conclusion There were no statistical significant difference of NLR between benign and prostate cancer group as a whole or in the subgroup analyses for patients who underwent RTPB. NLR may have a limited role in predicting early prostate cancer.