TY - JOUR
T1 - Significant upgrading affects a third of men diagnosed with prostate cancer
T2 - Predictive nomogram and internal validation
AU - Chun, Felix K H
AU - Briganti, Alberto
AU - Shariat, Shahrokh F.
AU - Graefen, Markus
AU - Montorsi, Francesco
AU - Erbersdobler, Andreas
AU - Steuber, Thomas
AU - Salonia, Andrea
AU - Currlin, Eike
AU - Scattoni, Vincenzo
AU - Friedrich, Martin G.
AU - Schlomm, Thorsten
AU - Haese, Alexander
AU - Michl, Uwe
AU - Colombo, Renzo
AU - Heinzer, Hans
AU - Valiquette, Luc
AU - Rigatti, Patrizio
AU - Roehrborn, Claus
AU - Huland, Hartwig
AU - Karakiewicz, Pierre I.
PY - 2006/8
Y1 - 2006/8
N2 - 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. PATIENTS AND 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 ≤6 to ≥7 or from 7 to ≥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%. CONCLUSION: Our nomogram might prove highly useful when the possibility of a more aggressive Gleason variant could change the treatment options.
AB - 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. PATIENTS AND 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 ≤6 to ≥7 or from 7 to ≥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%. CONCLUSION: Our nomogram might prove highly useful when the possibility of a more aggressive Gleason variant could change the treatment options.
KW - Gleason sum
KW - Nomogram
KW - Prostate biopsy
KW - Prostate cancer
KW - Significant upgrading
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U2 - 10.1111/j.1464-410X.2006.06262.x
DO - 10.1111/j.1464-410X.2006.06262.x
M3 - Article
C2 - 16879673
AN - SCOPUS:33745684251
SN - 1464-4096
VL - 98
SP - 329
EP - 334
JO - BJU international
JF - BJU international
IS - 2
ER -