title: The prognostic value of transrectal ultrasound guided biopsy in patients over 70 years old with a prostate specific Antigen (PSA) level ≤ 15 ng/ml and normal digital rectal examination: a 10-year prospective follow-up study of 427 consecutive patients.
abstract: BACKGROUND
  As a urologist, it is common to review a patient above the age of 70 being referred to a prostate assessments clinic with an elevated PSA. We evaluate the prognosis of these patients clinically as there is no international consensus on the exact PSA cutoff level or a single international guideline as to when these patients should be offered a prostate biopsy.
  
  
  METHODS
  On receiving ethic committee approval, we recruited 427 consecutive patients aged 70 years and above referred with a PSA of ≥ 4 ng/ml, from January 1996 to December 2000, into our study. All patients were assessed, examined with a digital rectal examination (DRE) of the prostate, and a subsequent prostate biopsy. We followed up on their histologic diagnosis for up to 10 years and analyzed their outcome. The main outcome measures were disease-free survival and overall survival, stratified according to the PSA level (≤ 15 vs. >15 ng/ml) and DRE findings (normal vs. sbnormal).
  
  
  RESULTS
  There was a statistically significant difference in the overall survival (P value < 0.011) and disease specific survival (P value < 0.0001) of cancer patients with a PSA was >15 ng/ml and an abnormal DRE. However, in patients with a PSA ≤ 15 ng/ml and normal DRE, the incidence of cancer was low and they had no disease-specific or overall survival benefit.
  
  
  CONCLUSIONS
  A policy of deferring prostate biopsy in patients with a PSA ≤ 15 ng/ml and normal DRE (Group A) would significantly decrease the need of unnecessary prostate biopsies. Within this group, patients did not have any survival advantage compared with those without cancer. We conclude that up to 20% of the prostate biopsies performed in this age group could have been avoided.
authors.affiliation: Department of Urology, Sunderland Royal Hospital, UK.
authors.forename: Zakir K
authors.initials: ZK
authors.lastname: Mohamed
authors.forename: Jose
authors.initials: J
authors.lastname: Dominguez-Escrig
authors.forename: Nikhil
authors.initials: N
authors.lastname: Vasdev
authors.forename: Balamurali
authors.initials: B
authors.lastname: Bharathan
authors.forename: Damian
authors.initials: D
authors.lastname: Greene
mesh_terms: D000368:Aged; D001706:Biopsy; D051517:Digital Rectal Examination; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000473:pathology*; D013997:Time Factors; D036761:Ultrasound, High-Intensity Focused, Transrectal
chemical_list: D017430:Prostate-Specific Antigen