Abstract
The current strategy for the histological assessment of prostate cancer (PCa) is mainly based on the Gleason score (GS). However, 30-40% of patients who undergo radical prostatectomy (RP) are misclassified at biopsy pathologically. Thus, we developed and validated nomograms for the prediction of Gleason score upgrading (GSU) in patients who underwent radical prostatectomy after extended prostate biopsy in a Chinese population. This retrospective study included a total of 411 patients who underwent radical prostatectomy at our institute after having prostate biopsies between 2011 and 2015. The final pathologic GS was upgraded in 151 (36.74%) of the cases in all patients and 92 (60.13%) cases in men with GS=6. In multivariate analyses, the primary biopsy GS, secondary biopsy GS and obesity were predictive of GSU in the patient cohort assessed. In patients with GS=6, the significant predictors of GSU included the body mass index (BMI), prostate-specific antigen density(PSAD) and percentage of positive cores. The area under the curve (AUC) of the prediction models was 0.753 for the entire patient population and 0.727 for the patients with GS=6. Both nomograms were well calibrated, and decision curve analysis demonstrated a high net benefit across a wide range of threshold probabilities. This study may be relevant for improved risk assessment and clinical decision-making in PCa patients.
Highlights
The Gleason score (GS) is the most widely accepted system for the grading of prostate cancer (PCa) [1]
The only informative predictors (P
We found that the primary biopsy GS and secondary biopsy GS values were significant predictors of GSU in all patients undergoing radical prostatectomy (RP), while the PSA, PSAD, number of positive biopsy cores, percentage of positive cores, and obesity were predictors of GSU in patients with GS=6
Summary
The Gleason score (GS) is the most widely accepted system for the grading of prostate cancer (PCa) [1]. Due to problems inherent with needle biopsy sampling, there is usually a difference between the GS at biopsy and the GS at radical prostatectomy (RP). The decision-making process regarding the treatment options for patients with PCa, such as active surveillance, radical prostatectomy, brachytherapy or cryosurgery, is highly reliant on GS. GS upgrading (GSU) after RP is highly associated with a risk of extracapsular extension (ECE) and biochemical recurrence (BCR) [2]. It is important that the presence of increasing quantities of Gleason pattern 4 results in an increased risk of biochemical disease recurrence, a need for adjuvant therapy, and cancerspecific mortality [3]. There are substantial differences in the outcomes between patients with a GS of 3+4 and 4+3 or higher [4]
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