Significant upgrading affects a third of men diagnosed with prostate cancer: predictive nomogram and internal validation.
OBJECTIVE
To explore the rate of significant upgrading from biopsy to radical prostatectomy (RP) specimens in a contemporary cohort, and to develop a prognostic model capable of predicting the probability of significant upgrading, as previous reports indicate that up to 43% of men with low-grade prostate cancer at biopsy will be diagnosed with high-grade cancer at RP.


METHODS
The study cohort comprised 4789 men (median age 63 years, range 39-82) treated with RP, with available clinical stage, prostate-specific antigen levels, biopsy and RP Gleason sum values. These variables were used as predictors in multivariate logistic regression models (LRMs) addressing the rate of significant Gleason sum upgrading, defined as a Gleason sum increase either from < or = 6 to > or = 7 or from 7 to > or = 8 between the biopsy and RP specimens. Regression coefficients were used to develop and validate (200 bootstrap re-samples) a nomogram predicting significant biopsy Gleason sum upgrading.


RESULTS
Significant biopsy Gleason sum upgrading was recorded in 1349 (28.2%) patients. In multivariate LRMs, all predictors were highly significant (all P < 0.001). The bootstrap-corrected accuracy of the nomogram predicting the probability of significant Gleason sum upgrading between biopsy and RP specimens was 75.7%.


CONCLUSIONS
Our nomogram might prove highly useful when the possibility of a more aggressive Gleason variant could change the treatment options.
Chun
Felix K-H
FK
Department of Urology, University of Hamburg, Hamburg, Germany.
Briganti
Alberto
A
Shariat
Shahrokh F
SF
Graefen
Markus
M
Montorsi
Francesco
F
Erbersdobler
Andreas
A
Steuber
Thomas
T
Salonia
Andrea
A
Currlin
Eike
E
Scattoni
Vincenzo
V
Friedrich
Martin G
MG
Schlomm
Thorsten
T
Haese
Alexander
A
Michl
Uwe
U
Colombo
Renzo
R
Heinzer
Hans
H
Valiquette
Luc
L
Rigatti
Patrizio
P
Roehrborn
Claus G
CG
Huland
Hartwig
H
Karakiewicz
Pierre I
PI
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology*; D012044:Regression Analysis
D017430:Prostate-Specific Antigen