Nomograms For Predicting Gleason Upgrading In A Contemporary Chinese Cohort Underwent Radical Prostatectomy After Extended Prostate Biopsy

Objective:To develop and validate nomograms for the prediction of Gleason score upgrading(GSU)in patients underwent radical prostatectomy after extended prostate biopsy in Chinese population.Methods:This retrospective study included a total of 411 patients underwent radical prostatectomy at our institute after prostate biopsies between 2011 and 2015.Prediction models were constructed based on multivariate logistic regression analyses.Receiver-operating characteristic(ROC)curve analyses,calibration curves analyses and decision curve analyses were applied to assess the performance of the prediction models and to validate the performance of the prediction model.Results:The final pathologic Gleason score(GS)was upgraded in in 151(36.74%)cases in overall patients and 92(60.13%)cases in men with GS=6.In multivariate analyses,primary biopsy Gleason score,secondary biopsy Gleason score and obesity were predictive of GSU in overall patients.In patients with GS=6,the significant predictors of GSU included BMI,PSAD and percentage of positive cores in multivariate analyses.The area under the curve(AUC)of the prediction models were 0.753(95%CI,0.706 to 0.800)for overall patients and 0.727(95%CI,0.647 to 0.808)for patients with GS=6.Both nomogram were well calibrated and decision curve analysis demonstrated high net benefit across a wide range of threshold probabilities.Conclusions:Prediction nomogram of GS were established in Chinese PCa patients.The performance of nomograms performed well and were well-validated internally in calibration curve analysis and decision curve analysis.This study may be of relevance in the risk assessment and clinical decision-making in prostate cancer patients.