Prostate Biopsy in the Elderly: Histologic Findings and Treatment Necessity

Abstract

The aim of this study is to determine results of high prostate specific antigen (PSA) or abnormal digitalrectal examination driven prostate biopsies performed in our Department in men aged 75 or more and to showthe characteristics of pathology results. The hospital records of the patients who had high PSA or abnormaldigital rectal examination driven prostate biopsy in two common university based research hospitals have beenreviewed retrospectively. Patients aged 75 years or older at the date of biopsy whose records provided pathologyresults and full medical history were evaluated for the study. A total of 103 patients were evaluated with a meanage of 79.4 ±3.4 years. More than half of the patients (55.1%) were in their seventh decade and the rest werein the eighth decade. Median PSA value was 15.0 (range 2.1-4500) ng/ml. In most of the biopsies (67%), PSAlevels were lower than 20 ng/ml. In almost half of the patients (48%), digital rectal examination was abnormal.In 68.9% of the patients, there were at least one or more associated co-morbid diseases. Gleason scores were 7or higher in 73%, and 8 or higher in 37% of the patients with prostate cancer. Four of the 70 (6%) patients hadbone metastases. Castrations were applied to most of the patients with prostate adenocarcinoma (%79). Highpercentage of high grade (Gleason 7 or more) prostate adenocarcinoma in the elderly refutes the perceptionof prostate cancer in this age group as clinically insignificant. Therefore, it is to be kept in mind that prostatecancer in the elderly an be clinically significant and prostate biopsies are to be performed when necessary.