title: Development and internal validation of a nomogram predicting the probability of prostate cancer Gleason sum upgrading between biopsy and radical prostatectomy pathology.
abstract: OBJECTIVE
  Previous reports indicate that as many as 43% of men with low grade PCa at biopsy will be diagnosed with high-grade PCa at RP. We explored the rate of upgrading from biopsy to RP specimen in our contemporary cohort, and developed a model capable of predicting the probability of biopsy Gleason sum upgrading.
  
  
  METHODS
  The study cohort consisted of 2982 men treated with RP, with available clinical stage, serum prostate specific antigen and biopsy Gleason scores. These clinical data were used as predictors in multivariate logistic regression models (LRM) addressing the rate of Gleason sum upgrading between biopsy and RP pathology. LRM regression coefficients were used to develop a nomogram predicting the probability of Gleason sum upgrading and was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias.
  
  
  RESULTS
  Overall, 875 patients were upgraded (29.3%). In multivariate LRMs, all predictors were highly significant (all p values <0.0001). Bootstrap-corrected predictive accuracy of the nomogram predicting the probability of Gleason sum upgrading between biopsy and RP was 0.804.
  
  
  CONCLUSIONS
  We developed a highly accurate clinical aid for treatment decision-making. It may prove useful when the possibility of a more aggressive Gleason variant may change the treatment options.
authors.affiliation: Department of Urology, University of Hamburg, Hamburg, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Andreas
authors.initials: A
authors.lastname: Erbersdobler
authors.forename: Eike
authors.initials: E
authors.lastname: Currlin
authors.forename: Jochen
authors.initials: J
authors.lastname: Walz
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Michael
authors.initials: M
authors.lastname: McCormack
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D001706:Biopsy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D049451:Nomograms; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D017430:Prostate-Specific Antigen