Patient and tumour characteristics in older patients (70 years or older) undergoing transperineal prostate biopsy: a retrospective cohort study

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BACKGROUNDS: PSA screening is advocated in men with a life expectancy of >10 years. With a rising mean life expectancy of 81 years in Australia, many men in their 70s have life expectancies of >10 years. Additionally, advanced age is an independent risk factor for high grade prostate cancer. Hence, we aimed to identify patient and disease characteristics and outcomes of men >70 years undergoing transperineal prostate biopsies (TPB) for suspected prostate cancer. METHODS: All patients aged 70 years old and above who underwent TPB for suspected prostate cancer between 1st January 2019 and 1st July 2022 at a large tertiary centre were identified. Data including patient Charlson Comorbidity Indices (CCI), pre-operative PSA, Multiparametric prostate MRI (mpMRI), histopathological results, subsequent intervention, and treatment intent (curative vs palliative) were obtained via scanned and electronic medical records. RESULTS: Of 229 patients, median age was 74 years and 72.5% patients had a CCI of ≤4 (>53% estimated 10-year survival). 80.8% were diagnosed with prostate cancer and 65.9% had ISUP ≥ 2 disease. 86.4% of patients with PIRADS 4 or 5 lesions resulted in clinically significant prostate cancer. 3.9% had mild biopsy complications. 76.8% of those with prostate cancer underwent treatment with curative intent. CONCLUSION: Men >70 years of age have a higher risk of clinically significant prostate cancer and low biopsy risk. Hence, many may benefit from early diagnosis and treatment. Decision on screening and further investigation should be based on assessment of individual risks, benefits and life expectancy.

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