Could prostate biopsies be avoided in men older than 75 years with raised PSA?
OBJECTIVE
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.
Department of Urology, Western General Hospital, Edinburgh, UK. mnomikos@gmail.com
Michael
M
Nomikos
Paramananthan
P
Mariappan
Alexandra
A
Zachou
Alan
A
McNeill
Prasad R
PR
Bollina
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D019992:Databases as Topic; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D012606:Scotland; D015854:Up-Regulation
D017430:Prostate-Specific Antigen