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Minerva Urologica e Nefrologica 2020 Aug 04

DOI: 10.23736/S0393-2249.20.03797-2


language: English

The role of metabolic syndrome in high grade prostate cancer: development of a clinical nomogram

Cosimo DE NUNZIO 1 , Giorgia TEMA 1, Riccardo LOMBARDO 1, Antonio CICIONE 1, Paolo DELL'OGLIO 2, Andrea TUBARO 1

1 Azienda Ospedaliera Sant’Andrea, Università “La Sapienza” Roma, Roma, Italy; 2 Department of Urology and Division of Experimental Oncology, URI, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy


BACKGROUND: The aim of our study is to develop a clinical nomogram including metabolic syndrome status for the prediction of high-grade prostate cancer (HG PCa).
METHODS: A series of men at increased risk of PCa undergoing prostate biopsies were enrolled in a single center. Demographic and clinical characteristics of the patients were recorded. Metabolic syndrome was defined according to the adult treatment panel III. A nomogram was generated based on the logistic regression model and used to predict high grade prostate cancer defined as grade group ≥ 3 (ISUP 2014). ROC curves, calibration plots and decision curve analysis were used to evaluate the performance of the nomogram.
RESULTS: Overall, 738 patients were enrolled. Greater than or equal to 294/738 (40%) of the patients presented PCa and of those patients, 84/294 (39%) presented high grade disease (Grade Group  3). On multivariate analysis, DRE (OR:3,24,95% CI: 1.80-5.84), PSA (OR:1.10,95%CI: 1.05-1.16), PV (OR:0,98.95%CI: 0,97-0,99) and MetS (OR:2.02.95%CI: 1.13-3.59) were predictors of HG PCa. The nomogram based on the model presented good discrimination (AUC:0.76), good calibration (Hosmer-Lemeshow test, p>0.05) and a net benefit in the range of probabilities between 10% and 70%.
CONCLUSIONS: Metabolic syndrome is highly prevalent in patients at risk of prostate cancer and is particularly associated with high-grade prostate cancer. Our nomogram offers the possibility to include metabolic status in the assessment of patients at risk of prostate cancer to identify men who may have a high-grade form of the disease. External validation is warranted before its clinical implementation.

KEY WORDS: High grade; Nomogram; Prostate cancer

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