Presentation Authors: Cosimo De Nunzio*, Riccardo Lombardo, Rome, Italy, Paolo Dell'Oglio, Milan, Italy, Antonio Nacchia, Francesca Lagrimino, Giorgia Tema, Fabiana Cancrini, Andrea Tubaro, Rome, Italy
Introduction: Metabolic syndrome (MetS) is associated with an increased risk of aggressive prostate cancer (PCa). However, MetS has not yet been included in the available nomograms used to predict the risk of high grade PCa. The aim of our study was to develop a clinical nomogram for the prediction of high grade PCa
Methods: A consecutive series of men undergoing prostate biopsies were enrolled in a single center. Indications for prostate biopsy included abnormal prostate specific antigen level (PSA>4ng/ml) and/or abnormal digital rectal examination (DRE). Patients with PSAâ‰¤50ng/ml were excluded from the analysis. 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 used to predict high grade prostate cancer defined as Epstein Gleason grade â‰¥3 (ISUP 2014).
Results: Overall 762 patients were enrolled. Mean age was 68Â±8 years, mean BMI was 27Â±5.6 and mean PSA was 6.4Â±6ng/ml. Overall 298/743 (40%) presented PCa and and out of them 87/298 (12%) presented high grade disease (Grade â‰¥3). Patients with high grade disease presented higher MetS rates when compared to patients with low grade disease (56%:49/87vs 33%:69/210, p=0.001). On multivariate analysis age (OR=1.04,95%CI: 1.01-1.08), DRE (OR=1.90,95%CI: 1.07-3.36), PSA (OR=1.06,95%CI: 1.02-1.10) and MetS (OR=2.02,95%CI: 1.17-3.5) were predictors of high grade disease. Calibration plot showed good calibration of the nomogram in the 10-50% probabilities. The nomogram predicting high grade PCa risk presented a predictive accuracy of 0.68.
Conclusions: Metabolic syndrome is highly prevalent in patients at risk of prostate cancer and it increases the risk of high grade prostate cancer. Our nomogram offers the possibility to include metabolic status in the assessment of patients with prostate cancer to identify men who are at risk of high grade disease. External validation is warranted before its clinical implementation.