Objective  To analyze the related factors for Gleason grade upgrading (GGU) after radical prostatectomy (RP) in patients with Gleason grade ≤ 4 by biopsy, and to establish a predictive Nomogram model.

  Methods  Clinical and pathological materials of 78 patients with Gleason grade ≤ 4 by biopsy and RP therapy in Henan Provincial People's Hospital from January 2017 to January 2020 were analyzed retrospectively. According to the Glason grade after RP, the patients was divided into elevated group (n=42) and non-elevated group (n=36). Univariate and multivariate Logistic regression analyses were used to analyze the associated factors for GGU, and the predictive Nomogram model was established on the basis of internal validation.

  Results  After receiving RP treatment, the Gleason grade were upgraded in 42 cases (53.8%), invariant in 24 cases (30.8%) and downgraded in 12 cases (15.4%). Multivariate Logistic regression analysis showed that the endocrine therapy before RP (OR=3.888, P=0.015), free prostate specific antigen (FPSA) (OR=1.185, P=0.036) and lymphocyte (OR=0.271, P=0.027) were correlated with GGU. Based on the above factors, the predictive Nomogram model was established and verified internally, the area under the curve (AUC) of the model was 0.779 (95%CI, 0.677 to 0.881), the C-index was 0.657, and the average absolute error was 2.0%.

  Conclusion  In patients with Gleason grade ≤ 4 by prostate biopsy, the patients with history of endocrine therapy before RP, increased FPSA and lower lymphocyte are more likely to suffer GGU after RP. The predictive Nomogram model based on the above factors has a certain clinical application value.