Are prostatic biopsies necessary in men aged > or =80 years?

Area of Science:

• Urology
• Oncology
• Geriatrics

Background:

• Prostate biopsies carry complication risks.
• Older men (> or =80 years) with prostate cancer often receive conservative management like 'watch and wait' or hormonal therapy.

Purpose of the Study:

• To evaluate the necessity of prostatic biopsies in men aged 80 years and older.
• To determine if biopsy findings alter management in this demographic.

Main Methods:

• Retrospective review of digital rectal examination (DRE), prostate-specific antigen (PSA) levels, biopsy, and bone scan results.
• Comparison between men aged > or = 80 years and a younger cohort (<80 years).
• Data from 205 men aged > or = 80 years undergoing prostatic biopsy over 3 years.

Main Results:

• Prostate cancer was confirmed in 79% of men aged > or = 80 years.
• Men with PSA > or = 30 ng/mL had a 97% cancer detection rate, with 92% having high-grade disease (Gleason grade > or = 7).
• In men with cancer and PSA > or = 30 ng/mL, 93% received hormonal withdrawal, and biopsies did not alter management in most cases.

Conclusions:

• Prostatic biopsy is questionable in men aged > or = 80 years with a PSA level > or = 30 ng/mL.
• High cancer prevalence and grade in this group suggest that biopsy may not be essential for management decisions.
• Conservative treatment is common, and biopsy results infrequently change this approach in elderly men.