Original investigation
Published: 2018-12-15

Elderly patients and prostate biopsy. How old is too old?

Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
Section of Pathological Anatomy, Department of Clinical and Experimental Medicine, University of Foggia, Italy
Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
Department of Urology, Mount Sinai School of Medicine, New York, USA
Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy
Elderly Prostate cancer Prostate biopsy High grade prostate cancer PSA screening Early diagnosis

Abstract

Background & aims. Based on autopsy finding that many elderly men bear clinically-insignificant prostate
cancer, physicians tend to be reluctant to advise PSA testing in men > 75y and to recommend prostate biopsy,
particularly in men who suffer from lower urinary tract symptoms. Herein, we compared the outcome of prostate
biopsy in men ≤ 75 and > 75y to determine whether such procedure is worth in the elderly patient.
Methods. We assessed the rates of prostate cancer and of clinically-significant prostate cancer in men ≤ 75
and > 75y who underwent prostate biopsy at our Institution. We also assessed prostate volume, peak flow rate,
post-void residual and International Prostate Symptoms Score.
Results. Of 3350 with PSA up to 20 ng/ml, 387 (11.5%) were > 75y. They had higher PSA, similar prostate
volume, lower Peak Flow rate and International Prostate Symptoms Score and higher post-void residual than
their younger counterpart. Prostate cancer detection rate was 62%, as opposed to 43% in their younger counterpart
(p < 0.0001); clinically-significant prostate cancer rate was 42.9% as opposed to 24% (p < 0.0001).
Findings were almost the same in the 2740 patients with PSA up to 10 ng/ml. Multivariate analysis pointed out
that all clinical variables independently predicted clinically-significant prostate cancer but elderly patients with
PSA up to 10 ng/ml had an almost 5-fold greater risk of such diagnosis than their younger counterpart.
Conclusions. Given their risk of harboring clinically-significant prostate cancer, elderly patients with rising PSA
deserve prostate biopsy as early detection may provide significant benefits in terms of disease-free and overall
survival.

Affiliations

U.G. Falagario

Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy

F. Sanguedolce

Section of Pathological Anatomy, Department of Clinical and Experimental Medicine, University of Foggia, Italy

G. Stallone

Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy

N. D’Altilia

Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy

A. Tewari

Department of Urology, Mount Sinai School of Medicine, New York, USA

G. Carrieri

Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Italy

Copyright

© Società Italiana di Gerontologia e Geriatria (SIGG) , 2018

How to Cite

[1]
Falagario, U., Sanguedolce, F., Stallone, G., D’Altilia, N., Tewari, A. and Carrieri, G. 2018. Elderly patients and prostate biopsy. How old is too old?. JOURNAL OF GERONTOLOGY AND GERIATRICS. 66, 4 (Dec. 2018), 163-167.
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