title: The novel nomogram of Gleason sum upgrade: possible application for the eligible criteria of low dose rate brachytherapy.
abstract: OBJECTIVE
  To examine the rate of Gleason sum upgrading (GSU) from a sum of 6 to a Gleason sum of ≥7 in patients undergoing radical prostatectomy (RP), who fulfilled the recommendations for low dose rate brachytherapy (Gleason sum 6, prostate-specific antigen ≤10 ng/mL, clinical stage ≤T2a and prostate volume ≤50 mL), and to test the performance of an existing nomogram for prediction of GSU in this specific cohort of patients.
  
  
  METHODS
  The analysis focused on 414 patients, who fulfilled the European Society for Therapeutic Radiation and Oncology and American Brachytherapy Society criteria for low dose rate brachytherapy (LD-BT) and underwent a 10-core prostate biopsy followed by RP. The rate of GSU was tabulated and the ability of available clinical and pathological parameters for predicting GSU was tested. Finally, the performance of an existing GSU nomogram was explored.
  
  
  RESULTS
  The overall rate of GSU was 35.5%. When applied to LD-BT candidates, the existing nomogram was 65.8% accurate versus 70.8% for the new nomogram. In decision curve analysis tests, the new nomogram fared substantially better than the assumption that no patient is upgraded and better than the existing nomogram.
  
  
  CONCLUSIONS
  GSU represents an important issue in LD-BT candidates. The new nomogram might improve patient selection for LD-BT and cancer control outcome by excluding patients with an elevated probability of GSU.
authors.affiliation: Martiniclinic, Prostate Cancer Center Hamburg-Eppendorf, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Budäus
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.forename: Georg
authors.initials: G
authors.lastname: Salomon
authors.forename: Hendrik
authors.initials: H
authors.lastname: Isbarn
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lughezzani
authors.forename: Maxine
authors.initials: M
authors.lastname: Sun
authors.forename: Felix K H
authors.initials: FK
authors.lastname: Chun
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schlomm
authors.forename: Thomas
authors.initials: T
authors.lastname: Steuber
authors.forename: Alexander
authors.initials: A
authors.lastname: Haese
authors.forename: Jens
authors.initials: J
authors.lastname: Koellermann
authors.forename: Guido
authors.initials: G
authors.lastname: Sauter
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.forename: Hans
authors.initials: H
authors.lastname: Heinzer
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.forename: Pierre I
authors.initials: PI
authors.lastname: Karakiewicz
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D001918:Brachytherapy; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D049451:Nomograms; D018579:Patient Selection; D011237:Predictive Value of Tests; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen; D011468:Prostatectomy; D011470:Prostatic Hyperplasia; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D018714:Radiotherapy, Adjuvant; D012720:Severity of Illness Index
chemical_list: D017430:Prostate-Specific Antigen