For older men with abnormal PSA levels, performance of prostate biopsies is uncommon and decreases with advancing age and worsening comorbidity, according to a study published online ahead or print in JAMA Internal Medicine.

Louise C. Walter, MD, from San Francisco Veterans Affairs (VA) Medical Center and University, and colleagues followed 295,645 men, aged 65 years or older, who underwent PSA screening in the VA health care system in 2003, for five years.

The researchers found that 8.5% of the cohort had an index PSA level exceeding 4.0 ng/mL. Thirty-three percent underwent at least one prostate biopsy during follow-up; 62.8% of these were diagnosed as having prostate cancer (PCa); and 82.1% received PCa treatment. The study found a significant decrease in prostate biopsy performance with advancing age and worsening comorbidity. For men with biopsy-detected cancer, treatment exceeded 75% even among men aged 85 years or older, those with a Charlson-Deyo Comorbidity Index of 3 or higher, and those with low-risk cancer. The risk of death from nonprostate cancer causes increased significantly with advancing age and worsening comorbidity among men with biopsy-detected cancer. Within seven days after prostate biopsy, 5.6% of men experienced complications. Treatment-related complications included new urinary incontinence (13.6%) and new erectile dysfunction (13.7%).

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“Decisions to pursue PSA screening should include individualized discussion about when to pursue biopsy and treatment because these steps substantially affect downstream outcomes of screening in clinical practice,” the investigators wrote.