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Clinically significant Gleason sum upgrade†
External validation and head-to-head comparison of the existing nomograms
Version of Record online: 5 JUL 2011
Copyright © 2011 American Cancer Society
Volume 118, Issue 2, pages 378–385, 15 January 2012
How to Cite
Iremashvili, V., Manoharan, M., Pelaez, L., Rosenberg, D. L. and Soloway, M. S. (2012), Clinically significant Gleason sum upgrade. Cancer, 118: 378–385. doi: 10.1002/cncr.26306
We thank the Center for Urologic Research, Education, and Diseases (CURED) and Mr. Vincent Rodriguez.
- Issue online: 5 JAN 2012
- Version of Record online: 5 JUL 2011
- Manuscript Accepted: 9 MAY 2011
- Manuscript Revised: 4 MAY 2011
- Manuscript Received: 9 MAR 2011
- prostate biopsy;
- prostatic neoplasms;
Several nomograms have been developed for the purpose of predicting the likelihood of an increase in Gleason sum (GS) from biopsy information compared with the GS determined after examination of the “entire prostate” in patients with prostate cancer. In this study, the authors evaluated and compared the ability of 4 nomograms (published by Capitanio et al, Chun et al, Kulkarni et al, and Moussa et al) to predict GS upgrades for patients with biopsy GS ≤6 prostate cancer who underwent radical prostatectomy (RP) at their center.
The entire study cohort included 942 patients with a biopsy GS ≤6. Predictive performances of the nomograms were compared using area under the receiver operating characteristic curve (AUC-ROC) analysis, calibration plots, and decision curve analysis (DCA) in the entire cohort, in patients with low-risk prostate cancer (LRPC), and a subgroup of those patients who underwent extended biopsy with ≥10 cores.
Patients with a GS ≥7 at prostatectomy included 319 of 942 patients (33.9%) in the entire study cohort, 263 of 814 patients (32.2%) with LRPC, and 84 of 301 patients (27.9%) with LRPC who underwent extended biopsy. With an AUC-ROC of 0.637 to 0.647 in the different subgroups of patients with low-risk cancer, the Kulkarni et al nomogram demonstrated significantly higher discriminative ability compared with the other nomograms. The same nomogram provided a small clinical benefit at DCA. All nomograms were poorly calibrated.
The available prognostic tools had limited ability to predict clinically significant upgrading in patients with biopsy GS ≤6 and, thus, the authors concluded that these tools are not ready for clinical application. Cancer 2011;. © 2011 American Cancer Society.