Are prostatic biopsies necessary in men aged ≥80 years?

Bott, Simon; Foley, Charlotte; Bull, Matthew; Reddy, Chaitanya; Freeman, Alex; Montgomery, Βruce; Langley, Stephen

doi:10.1111/j.1464-410x.2006.06603.x

Cited by 10 publications

(10 citation statements)

References 25 publications

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“…Bott et al [15] also demonstrated that in men 180 years with a PSA 130 ng/ml who have With a positive predictive value of 76.3% an abnormal DRE helped significantly in the diagnosis of prostate cancer in older men with PSA !20ng/ml. These men were also more likely to be placed on active monitoring in order to avoid possible treatment-related morbidity, but there were some with minor comorbidities and aggressive disease who received treatment with curative intent.…”

Section: Discussionmentioning

confidence: 99%

Could Prostate Biopsies Be Avoided in Men Older than 75 Years with Raised PSA?

Nomikos¹,

Mariappan²,

Zachou³

et al. 2010

Urol Int

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Objectives: Our purpose was to review current practice regarding the use of prostate biopsies in men older than 75 years with raised PSA by presenting the results of a retrospective audit and to identify these older men who really benefit from prostate biopsies. Methods: A high-volume tertiary center’s prospectively maintained prostate biopsy database of contemporary biopsies was reviewed. Men were stratified by age and PSA. Logistic regression analysis, Mantel-Haenszel and Fisher’s exact tests were used for statistical analysis. Results: Overall, 1,593 men underwent prostate biopsies between April 2004 and August 2006. Of these, 293 patients (18.4%) with a mean age of 82.62 years and mean PSA of 30.37 ng/ml were eligible for the study with an overall incidence of prostate cancer of 73.7%. Elderly men with PSA >20 ng/ml had a prostate cancer detection rate of 91%. They were more likely to have-high grade disease (OR = 5.4, 95% CI = 2.8–10.8, p < 0.0001) and receive hormone deprivation therapy (RR = 3.0, 95% CI = 2.1–4.3, p < 0.0001). Elderly men with PSA <20 ng/ml had a 3-fold risk of being placed on active monitoring. Almost 20% of them had 1 complication following biopsy, of whom 12 (4.1%) needed hospitalization. Conclusions: Given the high probability of detecting prostate cancer and receiving conservative treatment, prostate biopsies can be omitted in men >75 years with PSA >20 ng/ml. However, they are still useful in fit men >75 and <80 years with PSA <20 ng/ml who can be the potential candidates for treatment with curative intent.

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Section: Discussionmentioning

confidence: 99%

Could Prostate Biopsies Be Avoided in Men Older than 75 Years with Raised PSA?

Nomikos¹,

Mariappan²,

Zachou³

et al. 2010

Urol Int

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“…Indeed, previous studies have shown than PSA values as high as 10 ng/ml correlate poorly with the presence of prostate cancer in the elderly. 22,23 As such, the median PSA for which biopsy was deferred in this study was 7.2 ng/ml (IQR 5.4-11.7), raising questions as to the appropriate threshold for biopsy in this population.…”

Section: Discussionmentioning

confidence: 80%

Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease

Tosoian

Alam

Gergis

et al. 2017

Prostate Cancer Prostatic Dis

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Purpose To evaluate the relationship between PSA testing history and high-risk disease among older men diagnosed with prostate cancer. Materials and Methods Records from 1993 to 2014 were reviewed for men who underwent radiotherapy for prostate cancer at age 75 or older. Patients were classified into one of four groups based on PSA testing history: 1) no PSA testing, 2) incomplete/ineffective PSA testing, 3) PSA testing, or 4) cannot be determined. Outcomes of interest were National Comprehensive Cancer Network (NCCN) risk group (i.e. low, intermediate, or high risk) and biopsy grade at diagnosis. Multivariable logistic regression was used to determine the association between PSA testing history and high risk cancer. Results PSA testing history was available in 274 (94.5%) of 290 subjects meeting study criteria. In total, 148 men (54.0%) underwent PSA testing with follow-up biopsy, 72 (26.3%) underwent PSA testing without appropriate follow-up, and 54 men (19.7%) did not undergo PSA testing. Patients who underwent PSA testing were significantly less likely to be diagnosed with NCCN high risk cancer (23.0% vs. 51.6%, p<0.001). On multivariable analysis, men with no/incomplete PSA testing had more than three-fold increased odds of high risk disease at diagnosis (OR 3.39, 95% CI 1.96-5.87, p<0.001) as compared the tested population. Conclusions Older men who underwent no PSA testing or incomplete testing were significantly more likely to be diagnosed with high-risk prostate cancer than those who were previously screened. It is reasonable to consider screening in healthy older men likely to benefit from early detection and treatment.

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“…El 49% (35/72) de los pacientes analizados en nuestro estudio fueron diagnosticados de carcinoma de próstata, manteniéndose esta proporción si consideramos únicamente a los octogenarios (50%, 33/66). En un estudio similar realizado por Bott et al 16 la tasa de detección de cáncer de próstata en varones mayores de 80 años fue superior a la nuestra (79%). Independientemente de que esta serie inglesa es mucho más amplia (205 pacientes frente a 72) al tratarse de un estudio multicéntrico, dos factores pueden explicar los diferentes resultados.…”

Section: Discussionunclassified

“…Es decir, que probablemente se trataba de tumores en estadios más avanzados que los nuestros y, por lo tanto con mayor volumen tumoral, lo cual les hace ser más fácilmente detectables mediante las biopsias transrectales. Si consideramos únicamente los pacientes con PSA mayor de 20 ng/ml, la proporción de pacientes con cáncer de próstata es similar: 92% (93/101) frente a 88% (15/17) en nuestra serie, Otro factor a tener en cuenta es la diferente técnica empleada para el diagnóstico del cáncer de próstata: PAAF transrectal en nuestra serie y biopsia transrectal mediante tru-cut en la serie de Bott et al 16 . Podría interpretarse que la PAAF es menos sensible para la detección del cáncer de próstata que la biopsia, Sin embargo, no parece ser éste el caso, ya que aunque no hemos realizado un estudio comparativo entre ambas técnicas, nuestros resultados y los de la serie inglesa son similares en cuanto a tasas de detección cuando se estratifica a los pacientes según los niveles de PSA sérico.…”

Section: Discussionunclassified

“…Por todo ello, en algunos estudios se ha comenzado a cuestionar la indicación de la biopsia prostática transrectal en pacientes octogenarios con un alto gado de sospecha clínica de cáncer de próstata (PSA >30 ng/ml y/o tacto rectal sospechoso), dada la alta tasa de detección de cáncer de próstata en esta población (cercana al 100%) y el escaso impacto de los datos pronósticos del estudio histológico (grado de diferenciación, porcentaje de tumor en el material biopsiado) sobre las decisiones terapéuticas en estos pacientes 16,17 .…”

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Valor de la PAAF transrectal en el diagnóstico del cáncer de próstata en pacientes de edad avanzada

Gómez

Armada

Hernández

et al. 2008

Actas Urológicas Españolas

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In male patients older than 75 years with PSA > 30 ng/ml or with PSA > 20 ng/ml and suspicious digital rectal examination, histological confirmation of carcinoma by prostatic biopsy may be not necessary, because of the high probability of a positive result. When histological confirmation of prostatic carcinoma is required in elderly patients, transrectal prostatic FNA is a valid alternative to transrectal biopsy, due to its excellent tolerance and low complication rate.

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Are prostatic biopsies necessary in men aged ≥80 years?

Cited by 10 publications

References 25 publications

Could Prostate Biopsies Be Avoided in Men Older than 75 Years with Raised PSA?

Could Prostate Biopsies Be Avoided in Men Older than 75 Years with Raised PSA?

Unscreened older men diagnosed with prostate cancer are at increased risk of aggressive disease

Valor de la PAAF transrectal en el diagnóstico del cáncer de próstata en pacientes de edad avanzada

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