Do men aged 75 years and older need prostate biopsy?

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.