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Dear editor , Here within enclosed is our paper for consideration to be published on “The Saudi Medical Journal”. The further information about the paper is in the following: The Title: Predictors of Upgraded and Upstaged Prostate Cancer in Patients with Gleason score 6 or 7 at Biopsy The Authors: Shuai Liu1, Jiaqi Wang1, Kejia Ding2,Jiaju Lv3, Sentai Ding4, Jiming Zhao 5,Dongbin Bi6 1 ShandongProvincial Hospital Affiliated to Shandong University, Jina n 250021, P.R. China; 1 2 Shandong University, Jinan 250012, P.R. China; ShandongProvincial Hospital Affiliated to Shandong University, Jina n 250021, P.R. China; 3 ShandongProvincial Hospital Affiliated to Shandong University, Jina n 250021, P.R. China; 4 ShandongProvincial Hospital Affiliated to Shandong University, Jina n 250021, P.R. China; 5 ShandongProvincial Hospital Affiliated to Shandong University, Jina n 250021, P.R. China; 6 ShandongProvincial Hospital Affiliated to Shandong University, Jina n 250021, P.R. China; Brief introduction of our article: Prostate cancer (PCa) usually has extended natural history, with a significant controversy concerning the optimal treatment. One of the most important factors influencing treatment choice is the Gleason score (GS) from the initial prostate biopsy. Determination of whether a patient should be actively treated for low-risk prostate cancer remains controversial, as multiple studies have reported that a considerable proportion of men qualifying for active surveillance (AS) have aggressive tumor features at RP. The objective of this study was to examine the pathologic outcomes in men with GS 6 or 7 PCa who underwent RP and to identify preoperative factors including biopsy features that impact the incidence of upgrading and upstaging. These results in turn may aid in therapeutic management of patients with GS6 or7 tumor at initial diagnosis. The authors claim that none of the material in the paper has been published or is under consideration for publication elsewhere,and We declare that we have no conflict of interest. My work is suitable to your journal. I am the corresponding author and my address and other information is as follows, Address: DongBin Bi.Department of Urology, Provincial Hospital affiliated to Shandong University, 324 Jingwu Street, Jinan, China, 250021. E-mail: [email protected] Education background:Doctor Thank you very much for consideration! Sincerely Yours, DongBin Bi