Survival Outcomes for Men over 80 Years Undergoing Transrectal Ultrasound-Guided Prostate Biopsy: A Prospective Analysis.

Simple Summary: Prostate cancer is common among older men, and its diagnosis often involves a procedure called transrectal ultrasound (TRUS) biopsy, which helps detect cancer but also carries risks like infection and bleeding, particularly for elderly patients. This study evaluated the survival of men over 80 years of age to determine if undergoing a TRUS biopsy might improve their chances of surviving prostate cancer. By examining the records of 200 patients who had this biopsy, the study identified factors linked to poorer survival, including high levels of prostate-specific antigen, advanced cancer grade, and metastases. These findings can assist in a more accurate evaluation of the risks associated with TRUS biopsy in elderly patients and may guide future research toward developing safer or alternative strategies for diagnosing and managing prostate cancer in this population. Introduction: Prostate cancer is the second most prevalent cancer among elderly males in Western countries. TRUS biopsy remains a standard diagnosing approach for prostate cancer but poses notable risks, particularly in older men, including complications such as sepsis, acute retention, and rectal bleeding, which can lead to substantial morbidity and mortality. This study aimed to evaluate cancer-specific survival outcomes in men aged over 80 years and whether there is any cancer-specific survival advantage for TRUS biopsy procedure. Methods: Between January 2005 and December 2015, we studied outcomes of 200 patients (median age, 82 years) with elevated prostate-specific antigen (PSA) levels (>4.0 ng/mL) and/or abnormal digital rectal examination (DRE) who underwent TRUS biopsy. Each participant was followed up until death using an electronic system and a unique identifier in a defined geographical area. Cancer-specific and overall survival analyses were carried out utilising SPSS, while R Project was employed to construct and evaluate two nomograms survival duration and predict the risk of death post-biopsy. All statistical tests were two-tailed, with significance set at p < 0.05. Results: Amongst the participants, only 24 patients were alive at the end of follow-up (median age, 91 years). The PSA levels ranged from 4.88 to 102.7 ng/mL. Log-rank and Breslow tests indicated that higher PSA levels, the development of metastases, and ISUP grade group 8–10 were associated with shorter survival times. Age, co-morbid conditions, and tumour type were incorporated into the nomogram due to their clinical significance. Patients aged <81 years had lower mortality risk, while those aged >88 years faced higher mortality risks. Complications from the biopsy increased mortality risks in both cancerous and benign cases, and metastasis significantly heightened the likelihood of death. However, co-morbid conditions did not influence survival probability. Conclusions: Our findings underscore that older age (specifically 80 years and above), high Gleason score, metastasis, and elevated PSA levels are predictive of poorer survival outcomes in elderly men following TRUS biopsy. [ABSTRACT FROM AUTHOR]