The novel nomogram of Gleason sum upgrade: Possible application for the eligible criteria of low dose rate brachytherapy

Lars Budäus, Markus Graefen, Georg Salomon, Hendrik Isbarn, Giovanni Lughezzani, Maxine Sun, Felix Kh Chun, Thorsten Schlomm, Thomas Steuber, Alexander Haese, Jens Koellermann, Guido Sauter, Margit Fisch, Hans Heinzer, Hartwig Huland, Pierre I. Karakiewicz

Research output: Contribution to journalArticlepeer-review


Objective: To examine the rate of Gleason sum upgrading (GSU) from a sum of 6 to a Gleason sum of ≥7 in patients undergoing radical prostatectomy (RP), who fulfilled the recommendations for low dose rate brachytherapy (Gleason sum 6, prostate-specific antigen ≤10 ng/mL, clinical stage ≤T2a and prostate volume ≤50 mL), and to test the performance of an existing nomogram for prediction of GSU in this specific cohort of patients. Methods: The analysis focused on 414 patients, who fulfilled the European Society for Therapeutic Radiation and Oncology and American Brachytherapy Society criteria for low dose rate brachytherapy (LD-BT) and underwent a 10-core prostate biopsy followed by RP. The rate of GSU was tabulated and the ability of available clinical and pathological parameters for predicting GSU was tested. Finally, the performance of an existing GSU nomogram was explored. Results: The overall rate of GSU was 35.5%. When applied to LD-BT candidates, the existing nomogram was 65.8% accurate versus 70.8% for the new nomogram. In decision curve analysis tests, the new nomogram fared substantially better than the assumption that no patient is upgraded and better than the existing nomogram. Conclusions: GSU represents an important issue in LD-BT candidates. The new nomogram might improve patient selection for LD-BT and cancer control outcome by excluding patients with an elevated probability of GSU.

Original languageEnglish
Pages (from-to)862-868
Number of pages7
JournalInternational Journal of Urology
Issue number10
Publication statusPublished - Oct 2010


  • decision curve analysis
  • Gleason sum upgrading
  • low dose rate brachytherapy
  • prostate cancer

ASJC Scopus subject areas

  • Urology


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