Predicting Gleason sum upgrading from biopsy to radical prostatectomy pathology: a new nomogram and its internal validation

BackgroundTo explore the rate of Gleason sum upgrading (GSU) from biopsy to radical prostatectomy pathology and to develop a nomogram for predicting the probability of GSU in a Chinese cohort.MethodsWe retrospectively reviewed our prospectively maintained prostate cancer (PCa) database from October 2012 to April 2020. 198 patients who met the criteria were enrolled. Multivariable logistic regression analysis was performed to determine the predictors. Nomogram was constructed based on independent predictors. The receiver operating curve was undertaken to estimate the discrimination. Calibration curve was used to assess the concordance between predictive probabilities and true risks.ResultsThe rate of GSU was 41.4%, whilst GS concordance rate was 44.4%. The independent predictors are prostate specific antigen (PSA), greatest percentage of cancer (GPC), clinical T-stage and Prostate Imaging Reporting and Data System (PI-RADS) score. Our model showed good discrimination (AUC of 0.735). Our model was validated internally with good calibration with bias-corrected C-index of 0.726.ConclusionsUtilization of basic clinical variables (PSA and T-stage) combined with imaging variable (PI-RADS) and pathological variable (GPC) could improve performance in predicting actual probabilities of GSU in the 24-core biopsy scheme. Our nomogram could help to assess the true risk and make optimal treatment decisions for PCa patients.

Automated summary

The study found that the rate of Gleason sum upgrading in prostate cancer patients was 41.4%, while the Gleason sum concordance rate was 44.4%. Independent predictors included PSA, greatest percentage of cancer, clinical T-stage, and PI-RADS score, with the model showing good discrimination with an AUC of 0.735. The nomogram developed in the study could help assess the true risk and make optimal treatment decisions for prostate cancer patients.