Elderly patients and prostate biopsy. How old is too old?

Background & aims. Based on autopsy finding that many elderly men bear clinically-insignificant prostate cancer, physicians tend to be reluctant to advise PSA testing in men > 75y and to recommend prostate biopsy, particularly in men who suffer from lower urinary tract symptoms. Herein, we compared the outcome of prostate biopsy in men ≤ 75 and > 75y to determine whether such procedure is worth in the elderly patient. Methods. We assessed the rates of prostate cancer and of clinically-significant prostate cancer in men ≤ 75 and > 75y who underwent prostate biopsy at our Institution. We also assessed prostate volume, peak flow rate, post-void residual and International Prostate Symptoms Score. Results. Of 3350 with PSA up to 20 ng/ml, 387 (11.5%) were > 75y. They had higher PSA, similar prostate volume, lower Peak Flow rate and International Prostate Symptoms Score and higher post-void residual than their younger counterpart. Prostate cancer detection rate was 62%, as opposed to 43% in their younger counterpart (p < 0.0001); clinically-significant prostate cancer rate was 42.9% as opposed to 24% (p < 0.0001). Findings were almost the same in the 2740 patients with PSA up to 10 ng/ml. Multivariate analysis pointed out that all clinical variables independently predicted clinically-significant prostate cancer but elderly patients with PSA up to 10 ng/ml had an almost 5-fold greater risk of such diagnosis than their younger counterpart. Conclusions. Given their risk of harboring clinically-significant prostate cancer, elderly patients with rising PSA deserve prostate biopsy as early detection may provide significant benefits in terms of disease-free and overall survival.