Beyond the Abstract - Could prostate biopsies be avoided in men older than 75 years with raised PSA? by Michael Nomikos, MD, FEBU

BERKELEY, CA ( - The 10-year rule is the most frequently cited life expectancy benchmark for delivery of definitive therapy to patients with clinically localized prostate cancer.

Radical treatment is rarely offered in men with limited life expectancy as the risk of prostate cancer death is not substantially reduced, while the treatment-associated morbidity is higher in older men. Besides this, prostate biopsy alone can cause significant complications and increase the anxiety in this group of elderly men who most probably would not benefit from this procedure. Will prostate biopsy results influence the management of elderly patients with increased PSA?

In the present study, men >80 years had an overall prostate cancer incidence of 84% following prostate biopsy. Those men with PSA >20 ng/ml had a 91% incidence of prostate cancer and almost all (92.7%) received hormonal deprivation therapy. Older men with PSA <20ng/ml had a 3-fold risk of being placed on active monitoring. Only 5.5% of elderly men with PSA<20ng/ml and minor co morbidities received treatment with curative intent.

In many countries across Europe, prostate biopsies are still performed in this age group since tissue diagnosis is needed for the prescription of hormonal deprivation therapies.

Which of these elderly men with raised PSA will benefit from prostate biopsies? Irrespective of PSA values, men >80 years should avoid prostate biopsy performance. Men >75 years with PSA >20 ng/ml and abnormal DRE with a prostate cancer incidence of 94% can safely avoid biopsies as well.

Prostate biopsies in elderly men are only justified in the age group of 76–79 years with PSA <20 ng="" ml="" and="" minor="" comorbidities="" as="" this="" is="" the="" group="" of="" patients="" who="" could="" benefit="" from="" radical="" treatment="" should="" be="" informed="" risks="" benefits="" options="" aware="" potential="" complications="" prostate="" biopsies="" clinicians="" need="" to="" consider="" age="" comorbidity="" patient="" preferences="" before="" requesting="" a="" biopsy="" in="" elderly="" men="" further="" wellconducted="" studies="" are="" needed="" clarify="" which="" performance="" provide="" health="" systems="" with="" certain="" guidelines="" on="" field="" p="">

Written by:
Michael Nomikos, MD, FEBU as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Could prostate biopsies be avoided in men older than 75 years with raised PSA? - Abstract Prostate Cancer Section

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