ISUP grade upgrade prediction after radical prostatectomy: Role of Luteinizing Hormone to Testosterone ratio

This study aimed to evaluate the predictive value of the luteinizing hormone to testosterone (LH/T) ratio in postoperative International Society of Urological Pathology (ISUP) grade upgrading following radical prostatectomy.

Clinical data from 503 patients who underwent radical prostatectomy (RP) at Jiangsu Provincial People's Hospital between June 2022 and October 2024 were collected. A stratified random sampling method was used to divide the patients into a training set and a validation set at a 7:3 ratio. In the training set, binary logistic regression analysis was applied to identify key predictive factors for postoperative ISUP classification upgrading. A nomogram predictive model and a multivariate forest plot were constructed. The validation set was assessed using the bootstrap method for C-index, calibration curve, clinical impact curve (CIC) and decision curve analysis (DCA).

The postoperative ISUP upgrading rate was 31.2% (157/503). LH/T, Prostate Imaging Reporting and Data System (PI-RADS) score, preoperative ISUP grade and biopsy method were identified as key predictors of pathological upgrading. The C-index of the training set was 0.800, the validation set was 0.776, and the bootstrap resampling (500 times) in the validation set yielded a C-index of 0.799, indicating high sensitivity and specificity in distinguishing different categories. Calibration curves demonstrated consistency between predicted and actual values, while clinical impact curve (CIC) and DCA confirmed the model's ability to optimize preoperative decision-making.

A lower LH/T ratio is associated with a higher risk of ISUP grade upgrading. As a novel predictive biomarker, LH/T may enhance preoperative risk assessment, aiding in more precise treatment decisions for prostate cancer patients.