Abstract
Prostate specidic antigen (PSA) and digital rectal examination (DRE) are the known predictive factors for positive prostate biopsies differing according to the age, region and race. There have been only very limited studies about the impact of PSA on histological findings at prostate biopsy in Turkey. The aim of this study was to evaluate the impact of PSA and clinical stage on histologic findings of prostate biopsy in men older than 75 years of age as a first study in the Turkish population. A total of 1,645 consecutive prostate biopsies were included, with 194 men aged 75 or older. Cancer was identified in 104 patients (53.6%). Of the 104 positive biopsies, Gleason scores were less than 7 in 53 (49%) patients, 7 or greater in 51 (51%) patients. Positive prostate biopsies were significantly correlated with advanced age (p=0.0001), abnormal DRE (p=0.0001) and raised PSA (p=0.0001). The prostate volume was significantly correlated with advanced age especially in prostate cancer patients over 75 years, compared with those under 75 (p=0.0001). These results are useful for counseling men older than 75 years for prostate cancer detection. However, PCa screening decisions are currently based on urologist judgment and detection of latent asymptomatic disease is an important concern regarding costs, overdiagnosis, overtreatment and quality of life (QOL) for men aged 75 years and older. Healthy old patients with a long life expectancy need to be carefully evaluated for eligibility for PCa screening.
Highlights
Prostate cancer (PCa) is one of the most common cancers in the male population and diagnosed in 1 out of 6 men (Jemal et al, 2010)
An abnormal digital rectal examination (DRE) or an elevated age-specific Prostate specidic antigen (PSA) according to reference ranges were accepted as indication for prostate biopsy.PSA screening was performed by Beckman Coutter Kit, Hybretech, San Diego, CA, USA
All the cases were stratified by age, PSA levels, free and total PSA ratio, DRE findings, prostate volumes measured with transrectal ultrasound, results of cancer positive biopsies, Gleason scores according to histopathological results
Summary
Prostate cancer (PCa) is one of the most common cancers in the male population and diagnosed in 1 out of 6 men (Jemal et al, 2010). PSA-based screening in patients older than 75 years has long been controversial being an easy procedure, acceptable sensitivity and low costs. There are significant different therapeutic strategies in older and younger patients. This indicates that age alone has influenced urologist’s selection of therapeutic modalities (Situmorang et al, 2012). The prevalence of incidental PCa appears to be low in the Turkish population because the prevalence of PCa and high-grade prostatic intraepithelial neoplasia (HGPIN) were 33.3% and 16.7% beyond age 80, respectively in the limited number of autopsy study following trauma induced death (Polat et al, 2007)
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