Do men aged 75 years and older need prostate biopsy?

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Abstract

Aim. To evaluate advisability and safety of prostate biopsy in men aged ≥75 years with asymptomatic prostate cancer (PCa).

Materials and methods. The retrospective study included data of 206 patients aged ≥75 years with asymptomatic verified PCa. Median age was 83.0 (76.0–97.0) years. Indications for biopsy were increased prostate-specific antigen (PSA) level ≥4 ng/mL (188 (91.3 %)), palpable tumor of the prostate (8 (3.9 %)) or lesions identified using magnetic resonance imaging (MRI) and suspected for PCa (10 (4.8 %)). Median baseline PSA level was 11.9 (1.8–103.0) ng/mL. All patients underwent prostate biopsy.

Results. Complications of prostate biopsy were registered in 3 (1.5 %) of 206 patients. Adenocarcinoma of the prostate was verified in all cases (ISUP (International Society of Urological Pathology) grade 4–5 in 50 (24.3 %) samples). сТ3–4 category was diagnosed in 49 (23.8 %), сN1 – in 12 (5.8 %), сМ0 – in 206 (100 %) cases. The groups of intermediate unfavorable, high and very high risks included 133 (64.6 %) patients. Patients aged ≥80 years compared to patients aged 75–79 years demonstrated significantly increased rates of ISUP grade 4–5 adenocarcinomas (26.8 % vs.14.3 %), Т3–4 categories (26.8 % vs.11.9 %), and PCa of intermediate unfavorable, high and very high risks (68.3 % vs. 50/0 %) (p <0.05 for all). Frequency of detection of PCa of intermediate unfavorable, high and very high risks was significantly higher for PSA ≥10 ng/mL (p <0.0001) and was 100 % for MRI-detected lesions of the prostate PI-RADS 5 (Prostate Imaging Reporting and Data System). In 15 (7.3 %) cases, delayed treatment was administered, in 92 (44.6 %) cases – radical treatment, in 99 (48.1 %) – immediate drug treatment. Median follow-up was 38.6 (1.4–234.2) months, 17 (8.3 %) of 206 patients died including 4 (1.9 %) patients due to PCa. No differences in survival were observed in the treatment groups.

Conclusion. Prostate biopsy in men aged ≥75 years is associated with low complication rate. The frequency of detection of aggressive PCa forms in men aged ≥75 years is high and increases with age. Probability of detection of aggressive PCa significantly increased for baseline PSA ≥10 ng/mL and MRI-visualized prostate lesions PI-RADS 5.

About the authors

M. I. Volkova

Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia

Email: mivolkova@rambler.ru
ORCID iD: 0000-0001-7754-6624

Mariya Igorevna Volkova - Department of Oncology and Palliative Medicine, RMACPE

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152; Build. 1, 2/1 Barrikadnaya St., Moscow 125993

Russian Federation

I. S. Al-Akel

Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department

Author for correspondence.
Email: alakelibrahim1@gmail.com
ORCID iD: 0000-0002-2855-5767

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152

Russian Federation

Ya. V. Gridneva

Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

ORCID iD: 0000-0002-9015-2002

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152; 8 Trubetskaya St., Moscow 119991

Russian Federation

I. A. Pokataev

Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department

ORCID iD: 0000-0001-9864-3837

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152

Russian Federation

O. R. Sinitsina

Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department

ORCID iD: 0009-0003-7184-0410

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152

Russian Federation

S. A. Parts

Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department

ORCID iD: 0009-0003-9954-4584

Build. 7, 18A Zagorodnoe Shosse, Moscow 117152

Russian Federation

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