Avoid Prostate Biopsies In Octogenarians?

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Prostate biopsies may be unwarranted in men aged 80 years and older and who have a PSA level of 30 ng/mL, according to investigators in the U.K.

Simon R.J. Bott, MD, of The Royal Surrey County Hospital in Guildford, and his colleagues studied biopsies from 205 men aged 80 years and older. Of these, 163 (79%) had biopsy-confirmed prostate cancer, according to a report in BJU International (2006;99:335-338).

Prostate cancer was found in biopsy cores of all 29 men with a PSA level of 100 ng/mL or higher, 98% of 47 men with a PSA level of 50 ng/mL or higher, 97% of 76 men with a PSA level of 30 ng/mL or higher, and 92% of 101 men with a PSA level of 20 ng/mL or higher, and 63% of men with a PSA level below 20 ng/mL.

In men with cancer and a PSA level of 30 ng/mL or higher, 92% had Gleason grade 7 or higher, and 92% were treated with hormonal withdrawal alone. Digital rectal examinations were abnormal in all men with cancer.

The authors concluded that it might be possible to manage patients aged 80 years and older with a PSA level of 30 ng/mL without performing prostate biopsies or changing over-all treatment. Dr. Bott's group noted that a “pragmatic course must be steered” between exposing men with a limited life expectancy to the morbidity of prostate biopsies and managing them appropriately.

“Although every patient is an individual case,” they wrote, “we propose that in such patients, using a PSA threshold of 30 ng/mL above which a diagnosis of prostate cancer is assumed and treatment considered, represents such a balance of benefit and harm.”
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