Abstract
Objective. The aim of this study is to develop a prognostic model capable of predicting the probability of significant upgrading among Japanese patients. Methods. The study cohort comprised 508 men treated with RP, with available prostate-specific antigen levels, biopsy, and RP Gleason sum values. Clinical and pathological data from 258 patients were obtained from another Japanese institution for validation. Results. Significant Gleason sum upgrading was recorded in 92 patients (18.1%) at RP. The accuracy of the nomogram predicting the probability of significant Gleason sum upgrading between biopsy and RP specimens was 88.9%. Overall AUC was 0.872 when applied to the validation data set. Nomogram predictions of significant upgrading were within 7.5% of an ideal nomogram. Conclusions. Nearly one-fifth of Japanese patients with prostate cancer will be significantly upgraded. Our nomogram seems to provide considerably accurate predictions regardless of minor variations in pathological assessment when applied to Japanese patient populations.
Highlights
Pretreatment prostate-specific antigen (PSA) level, Gleason score, and pathological stage are generally recognized as significant predictors of biochemical recurrence in patients with clinically localized prostate cancer treated by radical prostatectomy (RP) [1]
Pretreatment PSA levels were measured before a digital rectal examination (DRE) and transrectal ultrasound (TRUS)
We investigated temporal changes in the rate of significant Gleason sum upgrading for two institutions
Summary
Pretreatment prostate-specific antigen (PSA) level, Gleason score, and pathological stage are generally recognized as significant predictors of biochemical recurrence in patients with clinically localized prostate cancer treated by radical prostatectomy (RP) [1]. A finding of high-grade disease in RP specimens is an adverse prognostic factor, and such tumors are significantly more likely to progress than organconfined cancers. This finding is associated with a greater risk of positive surgical margins, further decreasing the likelihood of long-term cancer control. Chun et al developed and validated a model predicting Gleason sum upgrading from biopsy to final pathology using clinical variables (PSA level, clinical stage, and biopsy Gleason sum) [3]. Development of a nomogram predicting the probability of biopsy Gleason sum upgrading in a large
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