Impact of PSA and DRE on Histologic Findings at Prostate Biopsy in Turkish Men Over 75 Years of Age

  • Published : 2013.10.30


Prostate specidic antigen (PSA) and digital rectal examination (DRE) are the known predictive factors for positive prostate biopsies differing according to the age, region and race. There have been only very limited studies about the impact of PSA on histological findings at prostate biopsy in Turkey. The aim of this study was to evaluate the impact of PSA and clinical stage on histologic findings of prostate biopsy in men older than 75 years of age as a first study in the Turkish population. A total of 1,645 consecutive prostate biopsies were included, with 194 men aged 75 or older. Cancer was identified in 104 patients (53.6%). Of the 104 positive biopsies, Gleason scores were less than 7 in 53 (49%) patients, 7 or greater in 51 (51%) patients. Positive prostate biopsies were significantly correlated with advanced age (p=0.0001), abnormal DRE (p=0.0001) and raised PSA (p=0.0001). The prostate volume was significantly correlated with advanced age especially in prostate cancer patients over 75 years, compared with those under 75 (p=0.0001). These results are useful for counseling men older than 75 years for prostate cancer detection. However, PCa screening decisions are currently based on urologist judgment and detection of latent asymptomatic disease is an important concern regarding costs, overdiagnosis, overtreatment and quality of life (QOL) for men aged 75 years and older. Healthy old patients with a long life expectancy need to be carefully evaluated for eligibility for PCa screening.


  1. Bokhorst LP, Bangma CH, van Leenders GJ, et al (2013). Prostate-specific antigen-based prostate cancer screening: reduction of prostate cancer mortality after correction for nonattendance and contamination in the rotterdam section of the European randomized study of screening for prostate cancer. Eur Urol, [Epub ahead of print].
  2. Alibhai SMH, Naglie G, Nam R, et al (2003). Do older men benefit from curative therapy of localized prostate cancer? J Clin Oncol, 21, 3318-27.
  3. Andriole GL, Crawford ED, Grubb RL, et al (2009). Mortality results from a randomized prostate-cancer screening trial. N Engl J Med, 360, 1310-9.
  4. Barry M (2006). The PSA conundrum. Arch Intern Med, 166, 7-8.
  5. Carter HB (2006). Assessing risk: does this patient have prostate cancer? J Natl Cancer Inst, 98, 506-7.
  6. Dale W, Bilir P, Han M, et al (2005). The role of anxiety in prostate carcinoma. Cancer. 104, 467-78.
  7. Eastham JA, May R, Robertson JL, et al (1999). Development of a nomogram that predicts the probability of a positive prostate biopsy in men with an abnormal digital rectal examination and a prostate-specific antigen between 0 and 4 ng/mL. Urology, 54, 709-13.
  8. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer, 127, 2893-917.
  9. Froehner M, Koch R, Wirth MP (2013). Comorbidity and survival of patients selected for radical prostatectomy at an age of 75 years or older. Asian J Androl, [Epub ahead of print].
  10. Jemal A, Siegel R, Xu J, et al (2010). Cancer statistics. CA Cancer J Clin, 60, 277-300.
  11. Garzotto M, Hudson RG, Peters L, et al (2003). Predictive modeling for the presence of prostate carcinoma using clinical, laboratory, and ultrasound parameters in patients with prostate specific antigen levels < or =10 ng/mL. Cancer, 98, 1417-22.
  12. Haas GP, Delongchamps NB, Jones RF, et al (2007). Needle biopsies on autopsy prostates; sensitivity of cancer detection based on true prevalence. J Natl Cancer Inst, 99, 1484-9.
  13. Heidenreich A, Bellmunt J, Bolla M, et al (2011). EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localized disease. Eur Urol, 59, 61-71.
  14. Lumen N, Fonteyne V, De Meerleert G, et al (2012). Population screening for prostate cancer: an overview of available studies and meta-analysis. Int J Urol, 19, 100-8.
  15. Nomikos M, Mariappan P, Zachou A, et al (2010). Could prostate biopsies be avoided in men older than 75 years with raised PSA? Urol Int, 85, 410-4.
  16. Ojewola RW, Tijani KH, Jeje EA, (2013). An evaluation of usefulness of prostate specific antigen and digital rectal examination in the diagnosis of prostate cancer in an unscreened population: experience in a Nigerian teaching hospital. West Afr J Med, 32, 8-13.
  17. Parker C, Muston D, Melia J, et al (2006). A model of the natural history of screen-detected prostate cancer, and the affect of radical treatment on overall survival. Br J Cancer, 94, 1361-8.
  18. Polat K, Tuzel E, Aktepe F, et al (2009). Investigation of the incidence of latent prostate cancer and high-grade prostatic intraepithelial neoplasia in an autopsy series of Turkish males. Turkish J Urol, 35, 96-100.
  19. Shigemura K, Arakawa S, Yamanaka K, et al (2008). Potential predictive factors of positive prostate biopsy in the Japanese population. Int Urol Nephrol, 40, 91-6.
  20. Roobol MJ, Zappa M, Maattanen L, et al (2007). The value of different screening tests in predicting prostate biopsy outcome in screening for prostate cancer data from a multicenter study (ERSPC). Prostate, 67, 439-46.
  21. Scattoni V, Sangalli M, Roscigno M, et al (2005). Detection and diagnosis of prostate cancer: what's new. Arch Ital Urol Androl, 77, 173-9.
  22. Schroder FH, Hugosson J, Roobol MJ, et al (2009). Screening and prostate-cancer mortality in a randomized European study. N Engl J Med, 360, 1320-8.
  23. Situmorang GR, Umbas R, Mochtar CA, et al (2012). differently? Asian Pac J Cancer Prev, 13, 4577-80.
  24. Taichman RS, Loberg RD, Mehra R, et al (2007).The evolving biology and treatment of prostate cancer. J Clin Invest, 117, 2351-61.
  25. Tuncer M (2007). Cancer control in Turkey. Turkish Ministry of Health Ankara, 1, 37-40.
  26. US Preventive Services Task Force (2008). Screening for prostate cancer: US preventive services task force recommendation statement. Ann Intern Med, 149, 185-91.
  27. Welch HG, Black WC (2010). Overdiagnosis in cancer. J Natl Cancer Inst, 102, 605-13.
  28. Wolf AM, Wender RC, Etzioni RB, et al (2010). American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin, 60, 70-98.

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