title: Significant upgrading affects a third of men diagnosed with prostate cancer: predictive nomogram and internal validation.
abstract: 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.
authors.affiliation: Department of Urology, University of Hamburg, Hamburg, Germany.
authors.forename: Felix K-H
authors.initials: FK
authors.lastname: Chun
authors.forename: Alberto
authors.initials: A
authors.lastname: Briganti
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Andreas
authors.initials: A
authors.lastname: Erbersdobler
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Andrea
authors.initials: A
authors.lastname: Salonia
authors.forename: Eike
authors.initials: E
authors.lastname: Currlin
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Martin G
authors.initials: MG
authors.lastname: Friedrich
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Uwe
authors.initials: U
authors.lastname: Michl
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Luc
authors.initials: L
authors.lastname: Valiquette
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: 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
chemical_list: D017430:Prostate-Specific Antigen