Are prostate biopsies necessary for all patients 75years and older?

To develop nomograms predicting prostate cancer (PCa) and high-grade PCa (HGPCa) in the elderly population.

We reviewed the data of patients aged 75years and older who underwent first-time prostate biopsy and multiparametric magnetic resonance imaging (mpMRI). The nomograms were developed based on multivariate analysis and evaluated. We performed the external validation and calibration of the risk calculators from the European Randomized Study of Screening for Prostate Cancer (ERSPC) and the Prostate Cancer Prevention Trial (PCPT).

The present study included 302 subjects with a median age of 78years (range: 75-91years). Overall, 225 and 129 subjects were diagnosed with PCa and HGPCa (Gleason score≥4+3), respectively. The ratio of free-to-total PSA, prostate-specific antigen density (PSAD), transrectal ultrasound (TRUS), and Prostate Imaging Reporting and Data System (PI-RADS) were used to develop the PCa-predicting nomogram, and PSAD, TRUS, and PI-RADS were used to develop the HGPCa-predicting nomogram. The area under the curve (AUC) values of PCa-predicting and HGPCa-predicting nomograms were 0.90 and 0.87. The ERSPC calculator had acceptable external calibration and validation outcomes. We recommended a cut-off probability of 42% for PCa-predicting nomogram when used in healthy older men to achieve a sensitivity of 95.6%, and a cut-off probability of 73% for HGPCa-predicting nomogram when used in vulnerable older men to achieve a specificity of 98.3%.

The present nomograms could help discriminate patients with PCa from healthy elder adults for standard treatment, and discriminate patients with HGPCa from vulnerable elder adults for modified treatment. External validation is expected.

Journal of geriatric oncology. 2017 Sep 19 [Epub ahead of print]

Yuke Chen, Yu Fan, Yang Yang, Jie Jin, Liqun Zhou, Zhisong He, Zheng Zhao, Qun He, Xiaoying Wang, Wei Yu, Shiliang Wu

Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China., Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China. Electronic address: ., Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China. Electronic address: ., Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China. Electronic address: ., Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China. Electronic address: ., Department of Radiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing 100034, China., Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China. Electronic address: ., Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China; Institute of Urology, Peking University, National Urological Cancer Center, 8 Xishiku Street, Xicheng District, Beijing 100034, China. Electronic address: .