Relevant patient records were retrospectively evaluated from January 2010 to December 2017. All patients were stratified into two groups: patients who were biopsied at an age between 75 and 79 years [group 1 - seniors] and patients who were biopsied at the age of 80 years or above [group 2 - super seniors (SS)].
Out of a total of 2700 biopsies, 363 (13.4%) relevant biopsies were included. The Senior group included 232 (63.9%) patients, and the super-senior group included 131 (36.1%) patients, with only 29 (8%) being older than 85 years. Most senior patients had an initial PSA of less than ten ng/mL (54.5%), and a large proportion of the Super senior patients had PSA greater than 20 ng/mL (43.3%). The pathological results revealed more advanced histology in Super senior patients, including higher ISUPs (ISUP 4-5 of 31.3% vs. 13.8%, ISUP 2 of 38.4% vs. 32.1%, and ISUP 1 of 27.6% versus 16.8%, p < 0.001), as shown in table 1. Additionally, the super senior patients had a higher incidence of bilateral disease (67.9 vs. 51.7%, p= 0.003), vascular invasion (19.1% vs. 7.8%, p=0.003) and lymphatic invasion (13% vs. 6.5%, p= 0.05).
Table 1 - Pathological results:
The initial treatment performed is demonstrated in table 2. The last mean PSA was 36.5 ± 143.6 ng/mL and was not different between the groups (p=0.1). Only 31.4% (n=114) of patients had died (24.6% vs 43.5%, p < 0.001). The Senior patients lived for 77.4± 2.8 months compared to the super senior patients, who lived for 62.3± 3.7 months following a prostate cancer diagnosis, p < 0.001. In univariate analysis, there was a statistically significant association between death and: initial PSA, several pathological variables, initial treatment, metastasis, hospitalizations, and emergency department consultations (p < 0.05). However, in the multivariable analysis, only age at biopsy showed a statistically significant association with death (p = 0.03). The Kaplan Meier curve comparing overall survival between the senior and super senior groups is shown in figure 1.
Table 2 – Initial treatment:
Figure 1: Kaplan Meier curve showing overall survival rate in the senior and super senior groups:
The authors concluded that prostate biopsy was performed in the super senior group at a higher PSA level than in the senior group. Consequently, these patients had more aggressive histology with a higher incidence of bilateral and lymphovascular invasion. The only factor limiting survival was the age at biopsy.
Speaker: Joao Carvalho, MD, Department of the Coimbra University Hospital Center, Coimbra, Portugal
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois