Are prostate biopsies necessary for all patients 75 years and older?. Issue 2 (March 2018)

• Record Type: Journal Article
• Authors: Chen, Yuke; Fan, Yu; Yang, Yang; Jin, Jie; Zhou, Liqun; He, Zhisong; Zhao, Zheng; He, Qun; Wang, Xiaoying; Yu, Wei; Wu, Shiliang
• Is Part Of: Journal of geriatric oncology. Volume 9:Issue 2(2018)
• Page Start: 124
• Page End: 129
• Publication Date: 2018-03
• Subjects: The elderly population -- Prostatic neoplasms -- Prostate biopsy -- Prostate specific antigen -- Multiparametric magnetic resonance imaging -- Prediction; Geriatric oncology -- Periodicals; Neoplasms -- Periodicals; Aged -- Periodicals; Geriatric oncology; Electronic journals; Periodicals; 618.976994005
• DOI: 10.1016/j.jgo.2017.09.001
• Languages: English
• ISSNs: 1879-4068

Abstract

Abstract: Purpose: To develop nomograms predicting prostate cancer (PCa) and high-grade PCa (HGPCa) in the elderly population. Methods: We reviewed the data of patients aged 75 years 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). Results: The present study included 302 subjects with a median age of 78 years (range: 75–91 years). 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%. Conclusions: 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.