Clinical predictors of Gleason score upgrading: implications for patients considering watchful waiting, active surveillance, or brachytherapy.

摘要: BACKGROUND Brachytherapy, active surveillance, and watchful waiting are increasingly being offered to men with low-risk prostate cancer. However, many of these harbor undetected high-grade disease (Gleason pattern ≥4). The ability identify those individuals occult may help guide treatment decisions in this patient cohort. METHODS The authors identified 175 cases cancer treated radical prostatectomy. By using logistic regression analysis, 11 a priori-defined preoperative risk factors were evaluated for their predict upgrading from Gleason 6 at biopsy ≥7 An internally validated nomogram all clinical variables was subsequently created physicians patients who had disease. RESULTS A total 60 (34%) upgraded disease. On multivariate analyses, both prostate-specific antigen (PSA) level (P = .02) the pathologist expertise .007) predictive upgrading. contained plus age, digital rectal examination, transrectal ultrasound results, scheme applied (sextant vs extended), presence prostatic intraepithelial neoplasia, gland volume, percentage biopsy. provided acceptable discrimination (C statistic 0.71). CONCLUSIONS The significant predictors diagnosed A based on study findings could further risk-stratify before embarking treatment. Caution should be exercised recommending nonradical therapy high probability Cancer 2007. © 2007 American Society.