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The prognostic nomogram for PSA-incongruent low-risk prostate cancer treated by radical prostatectomy

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Abstract

Objective

To establish a prognostic nomogram for PSA-incongruent low-risk prostate cancer (PCa) patients (Gleason score 6 and clinical stage T2a) at diagnosis and treated with radical prostatectomy (RP), based on clinical and pathological metrics.

Methods

In total, 217 patients diagnosed with PCa were included in this study. All patients had a Gleason score of 6 (GS6) in biopsy, had clinical T2a before surgery and were treated with RP. Biochemical progression-free survival (bPFS) was analyzed using the Kaplan–Meier method. Univariate and multivariate analyses were used to determine prognostic factors related to bPFS. A prognostic nomogram was established based on factors that were significant in the multivariate analyses.

Results

The median bPFS had a significant difference in the subgroup of PSA at diagnosis (‘ < 10 ng/mL’: 71.698 [67.549–75.847] vs ‘10–20 ng/mL’: 71.038 [66.220–75.857] vs ‘ ≥ 20 ng/mL’: 26.746 [12.384–41.108] months [Log Rank P < 0.001]), the subgroup of T stage upgrade (Negative: 70.016 [65.846–74.187] vs ‘T2b/c’: 69.183 [63.544–74.822] vs ‘T3/4’: 32.235 [11.877–52.593] months [Log Rank P < 0.001]) and the subgroup of Gleason score upgrade (Negative: 72.63 [69.096–76.163] vs ‘3 + 4’: 68.393 [62.243–74.543] vs ‘4 + 3’: 41.427 [27.517–55.336] vs ‘ ≥ 8’: 28.291 [7.527–49.055] [Log Rank P < 0.001]). PSA at diagnoses (Hazard Ratio (HR) 1.027, 95% CI 1.015–1.039, P < 0.001), T stage upgrade (HR 2.116, 95% CI 1.083–4.133, P = 0.028), and Gleason score upgrade (HR 2.831, 95% CI 1.892–4.237, P < 0.001) were identified as independent predictors with significance in multivariable Cox regression analysis. A nomogram was established based on these three factors.

Conclusions

Our study indicated that PSA-incongruent low-risk PCa patients (PSA with 10–20 ng/mL) had a similar prognosis to those with real low-risk PCa (PSA < 10 ng/mL) in the D’ Amico criteria. We also established a nomogram based on three significant prognostic factors, including PSA at diagnosis, T stage upgrade, and Gleason score upgrade, which were associated with clinical outcomes in prostate cancer patients with GS6 and T2a after surgery.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

This study was supported by the Clinical Research Plan of the SHDC (No. SHDC2020CR3014A).

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Author notes

  1. Yan Wang and Yinjie Zhu contributed equally.

Authors and Affiliations

  1. Department of Urology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, 200127, China

    Yan Wang, Yinjie Zhu, Liancheng Fan, Jiazhou Liu, Jiahua Pan & Wei Xue

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  1. Yan Wang
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  2. Yinjie Zhu
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  3. Liancheng Fan
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  4. Jiazhou Liu
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  5. Jiahua Pan
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  6. Wei Xue
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Contributions

YW and YZ: contributed to the design and implementation of the research, YW and JP to the analysis of the results and to the writing of the manuscript. WX: conceived the original and supervised the project.

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Correspondence to Jiahua Pan or Wei Xue.

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Wang, Y., Zhu, Y., Fan, L. et al. The prognostic nomogram for PSA-incongruent low-risk prostate cancer treated by radical prostatectomy. Int Urol Nephrol 55, 1447–1452 (2023). https://doi.org/10.1007/s11255-023-03560-x

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  • DOI: https://doi.org/10.1007/s11255-023-03560-x

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