Presentation Authors: Joao Carvalho*, Pedro Nunes, Joao Lima, Rui Caetano, Hugo Antunes, Edgar Tavares-da-Silva, Belmiro Parada, Vítor Sousa, Maria Cipriano, Arnaldo Figueiredo, Coimbra, Portugal
Introduction: Prostate cancer is the second most diagnosed male cancer, with a growing prevalence at autopsies (59% at ages greater than 79 years). The risk of developing clinical disease is 10-20%, so biopsy may be considered in elderly patients. The objective is to evaluate the outcome of patients with more than 75 years who underwent prostate biopsy at our institution.
Methods: The records were retrospectively evaluated from January 2010 to December 2017. Two groups were created: patients whose age at biopsy was between 75 and 79 years [group 1 - seniors (S)] and equal or more than 80 years [group 2 â€“ super seniors (SS)]. The SPSS Statistics 23.0 software was used and p value < 0.05 was accepted as statistically significant.
Results: Of 2700 biopsies, 363 (13.4%) were included. S group included 232 (63.9%) and SS group included 131 (36.1%), with only 29 (8%) being older than 85 years. The majority of S patients had initial PSA less than 10 ng/mL (54.5%; median PSA: 9.2 Â± 226.2 ng/mL) and the majority of SS patients had PSA greater than 20 ng/mL (43.3%; median PSA: 16.5Â±287.0 ng/ml) p < 0.001. Pathology revealed more advanced histology in SS group, including higher ISUPs [ISUP 4-5 in SS (13.8% vs 31.3%) and ISUP 2 (38.4% versus 32.1%) and ISUP 1 (27.6% versus 16.8%) in S group, p < 0.001], higher incidence of bilateral disease (51.7% vs 67.9%, p= 0.003), vascular (7.8% vs 19.1%, p=0.003) and lymphatic invasion (6.5% vs 13.0%, p= 0.05). The initial treatment performed was: classic hormonotherapy (69.8% vs 92.4%), radical radiotherapy (17.7% vs 0.8%), watchful waiting (6.9 vs 6.1%), radical prostatectomy (4.3% vs 0%) and brachytherapy (1.3% vs. 0.8%), p < 0.001. Only 6.6% (n=24) had metastasis at beginning.The last mean PSA was 36.5 Â± 143.6 [0.01-1467.3] ng/mL and was not different between groups (p=0.1). Only 31.4% (n=114) of patients died (24.6% vs 43.5%, p < 0.001). The S patients lived for 77.4 Â± 2.8 months vs 62.3 Â± 3.7 months after prostate cancer diagnosis, p < 0.001.In univariate analysis, there was a statistically significant association between death and: initial PSA, several pathological variables, initial treatment, metastasis, hospitalizations and emergency department consultations, p < 0.05. However, in the multivariate analysis, only age at biopsy showed a statistically significant association with death (p = 0.03).
Conclusions: Prostate biopsy was performed in the super seniors groups, mainly when the initial PSA was higher. These patients had a more aggressive histology with a higher incidence of bilateral and lymphovascular invasion. However, the only factor that limited survival was the age at biopsy.