Age as a Predictor of Prostate Cancer Risk Stratification in Systematic Prostate Biopsy.

Abstract

Background: To evaluate the correlation between age and prostate pathological outcomes obtained through systematic transrectal prostate biopsy in 50- to 80-year-old patients with prostate-specific antigen levels ranging from 2.5 to 25 ng/mL.

Methods: This retrospective study included 1079 patients aged 50-80 years who underwent transrectal ultrasound-guided prostate biopsy. The patients were divided into two primary age groups: 50-65 years and 66-80 years. Additionally, the patients were stratified into six 5-year age subgroups (50-55, 56-60, 61-65, 66-70, 71-75, and 76-80 years). Pathological outcomes were compared between these primary age groups and subgroups.

Results: The prostate cancer detection rate increased from 27.6% in patients aged 50-65 years to 46.4% in those aged 66-80 years (p < = 0.001). Clinically significant prostate cancer was more frequent in patients older than 70 years. The International Society of Urological Pathology (ISUP) grade groups 3 and 4 were significantly more common in patients aged 76-80 years than in those under 70 years (p < = 0.001). No significant differences were observed for the ISUP grade groups 2 and 5. For grade group 1, a significant difference was found only between the 61-65 and 66-70-year age groups.

Conclusions: This study revealed that the detection rates of clinically significant prostate cancer and higher ISUP grade groups (especially grades 3 and 4) increased notably after age 65 years. These findings highlight the importance of age-adjusted risk assessment and individualized prostate-specific antigen screening and biopsy strategies. Further prospective studies are needed to refine protocols for older patients.