TY - JOUR
T1 - The probability of Gleason score upgrading between biopsy and radical prostatectomy can be accurately predicted
AU - Capitanio, Umberto
AU - Karakiewicz, Pierre I.
AU - Jeldres, Claudio
AU - Briganti, Alberto
AU - Gallina, Andrea
AU - Suardi, Nazareno
AU - Cestari, Andrea
AU - Guazzoni, Giorgio
AU - Salonia, Andrea
AU - Montorsi, Francesco
PY - 2009/5
Y1 - 2009/5
N2 - The objective of this study was to test the external validity of a previously developed nomogram for the prediction of Gleason score upgrading (GSU) between biopsy and radical prostatectomy (RP). The study population consisted of 973 assessable patients treated with RP at a tertiary care institution. The accuracy of the nomogram was quantified with the receiver operating characteristics curve-derived area under the curve. The performance characteristics (predicted vs observed rate of GSU) were tested within a calibration plot. Overall, GSU was recorded in 39.8% (n = 387) of patients at RP. Of patients with GSU, 70 (18.1%), 23 (5.9%) and 32 (8.3%), respectively, had extracapsular extension, seminal vesicle invasion and lymph node invasion. The accuracy of the nomogram was 74.9% (confidence interval 72.1-77.6%). The model tended to underestimate the observed rate of GSU and the discordance between the predicted and observed rate of GSU ranged from -7 to +10%. The current tool represents the most accurate method of predicting GSU between biopsy and RP. Nonetheless it is not perfect and its performance characteristics should be known prior to its use in clinical decision-making.
AB - The objective of this study was to test the external validity of a previously developed nomogram for the prediction of Gleason score upgrading (GSU) between biopsy and radical prostatectomy (RP). The study population consisted of 973 assessable patients treated with RP at a tertiary care institution. The accuracy of the nomogram was quantified with the receiver operating characteristics curve-derived area under the curve. The performance characteristics (predicted vs observed rate of GSU) were tested within a calibration plot. Overall, GSU was recorded in 39.8% (n = 387) of patients at RP. Of patients with GSU, 70 (18.1%), 23 (5.9%) and 32 (8.3%), respectively, had extracapsular extension, seminal vesicle invasion and lymph node invasion. The accuracy of the nomogram was 74.9% (confidence interval 72.1-77.6%). The model tended to underestimate the observed rate of GSU and the discordance between the predicted and observed rate of GSU ranged from -7 to +10%. The current tool represents the most accurate method of predicting GSU between biopsy and RP. Nonetheless it is not perfect and its performance characteristics should be known prior to its use in clinical decision-making.
KW - Decision-making
KW - Gleason score upgrading
KW - Nomogram
KW - Radical prostatectomy
UR - http://www.scopus.com/inward/record.url?scp=65449163032&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=65449163032&partnerID=8YFLogxK
U2 - 10.1111/j.1442-2042.2009.02270.x
DO - 10.1111/j.1442-2042.2009.02270.x
M3 - Article
C2 - 19389085
AN - SCOPUS:65449163032
VL - 16
SP - 526
EP - 529
JO - International Journal of Urology
JF - International Journal of Urology
SN - 0919-8172
IS - 5
ER -