Development and Validation of a Nomogram for Predicting Pathological Upgrading in Men With Biopsy Gleason 3 + 3...

Area of Science:

• Urology
• Oncology
• Medical Informatics

Background:

• Pathological upgrading is common in Gleason score 3+3 prostate cancer patients after radical prostatectomy.
• Accurate preoperative risk identification is crucial for prognosis and treatment planning.
• This study addresses the need for predictive tools in this specific patient population.

Purpose of the Study:

• To develop and internally validate a predictive nomogram for pathological upgrading.
• To identify preoperative clinical variables associated with pathological upgrading.
• To assist in individualized preoperative decision-making for men with Gleason score 3+3 prostate cancer.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Results (SEER) database for 14,484 patients with biopsy Gleason score 3+3 prostate cancer.
• Employed multivariable logistic regression to build a prediction model using preoperative clinical data.
• Assessed model performance via discrimination (AUC), calibration (Brier score), and decision curve analysis, with internal validation through bootstrapping and cross-validation.

Main Results:

• Nearly half (47.9%) of patients experienced pathological upgrading to Gleason score 3+4 or higher.
• Key predictors for upgrading included age, prostate-specific antigen (PSA) level, number of positive biopsy cores, and clinical T stage.
• The nomogram demonstrated moderate predictive performance with an AUC of 0.663 in the training cohort and 0.648 in the validation cohort.

Conclusions:

• The developed nomogram offers moderate predictive accuracy for pathological upgrading in men with biopsy Gleason score 3+3 prostate cancer.
• This tool can support preoperative decision-making for patients undergoing radical prostatectomy.
• Further refinement may enhance its utility in clinical practice.