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01-02-2017 | Original Article

A proposal of a new nomogram for predicting upstaging in contemporary D’Amico low-risk prostate cancer patients

Authors: Sami-Ramzi Leyh-Bannurah, Paolo Dell’Oglio, Zhe Tian, Jonas Schiffmann, Shahrokh F. Shariat, Nazareno Suardi, Montorsi Francesco, Briganti Alberto, Hans Heinzer, Hartwig Huland, Markus Graefen, Lars Budäus, Pierre I. Karakiewicz

Published in: World Journal of Urology | Issue 2/2017

Abstract

Purpose

Unfavorable prostate cancer (PCa) disease at final pathology affects at least 10 % of D’Amico low-risk patients. Thus, conservative therapies including active surveillance may be wrongfully applied. The purposes were to assess the rate of upstaging in a contemporary cohort of D’Amico low-risk PCa patients and to develop and externally validate a nomogram as upstaging prediction tool in two European cohorts.

Methods

Analyses were restricted to 2007 patients who harbored low-risk PCa at ≥10-cores initial biopsy according to D’Amico classification (PSA <10.0 ng/ml, Gleason score <7 and clinical stage ≤T2a). Patients underwent radical prostatectomy at a high-volume center in Hamburg, Germany, from 2010 to 2015. The Hamburg cohort was randomly divided into development (n = 1338) and validation cohorts (n = 669). The development cohort was used to devise a nomogram predicting upstaging, defined as presence of ≥pT3 and/or lymph node invasion. The nomogram was externally validated in two European validation cohorts (Hamburg, n = 669; Milan, n = 465).

Results

Upstaging was observed in 187/1338 (14.0 %) of low-risk patients. In multivariable models, four of ten tested variables achieved independent predictor status: age (OR 1.07, 95 % CI 1.04–1.09), PSA (OR 1.21, 95 % CI 1.12–1.31), prostate volume (OR 0.97, 95 % CI 0.96–0.98) and percentage of positive cores (OR 1.02, 95 % CI 1.01–1.03). In external validation, the nomogram demonstrated 70.8 % (Hamburg) and 70.0 % (Milan) accuracy, respectively, with excellent concordance between predicted and observed values.

Conclusions

Our proposed nomogram is capable to accurately identify D’Amico low-risk patients at risk of upstaging, utilizing four routinely available clinical variables, age, PSA, prostate volume and percentage of positive biopsy cores.

Patient summary

Unfavorable prostate cancer disease at final pathology affects at least 10 % of D’Amico low-risk patients. Thus, we developed and externally validated a new nomogram based on contemporary low-risk prostate cancer patients to accurately identify D’Amico low-risk patients at risk of upstaging. It utilizes four routine variables, age, PSA, prostate volume and percentage of positive biopsy cores.

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Title: A proposal of a new nomogram for predicting upstaging in contemporary D’Amico low-risk prostate cancer patients
Authors: Sami-Ramzi Leyh-Bannurah
Paolo Dell’Oglio
Zhe Tian
Jonas Schiffmann
Shahrokh F. Shariat
Nazareno Suardi
Montorsi Francesco
Briganti Alberto
Hans Heinzer
Hartwig Huland
Markus Graefen
Lars Budäus
Pierre I. Karakiewicz
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 2/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1863-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A proposal of a new nomogram for predicting upstaging in contemporary D’Amico low-risk prostate cancer patients

Abstract

Purpose

Methods

Results

Conclusions

Patient summary

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Patient summary

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