Prostate cancer severity prediction in advanced age groups in low incidence region

Objectives: To explore the relationship between prostate cancer (PCa) aggressiveness and the advanced age at diagnosis. Materials and methods: Men who had high Prostate-specific antigen (PSA) (>4ng/ml) were referred to the urology clinic for further evaluation by MRI, and those with positive findings were scheduled for a biopsy. Depending on its size, a systematic 12-core procedure was employed in each patient, following the extraction of 2-6 cores from the identified lesion. Non-significant prostate cancer had a Gleason score (GS) lower than 3 + 4, whereas significant PCa was categorized as having a GS of 3 + 4 or higher. Results: Out of all screened 6482 cases, 75 were diagnosed as clinically significant cancer (CSC) cases, and 21 were non-clinically significant. Age was significantly correlated with CSC in univariate analysis, where the percentage of CSC cases increased with increased age categories, and it was a significant independent predictor in all multivariate models. Its discriminative ability is high (AUC=0.75). The percentage of CSC cases (63.6%) is significantly higher in the smallest volume category (≤33 cc) in comparison to the 34-60 cc category (29.5%) and >60 cc category (31.8%). The interaction parameter, age-prostate volume, was a significant independent predictor of CSC, particularly for the smaller prostate volume (<33 cc). Conclusions: Age is considered a significant independent predictor of CSC, in general, and for older men in specific. The ability of prostate size to detect CSC becomes higher when interacting with age, particularly for small prostate size.