Alghamdi Dareen, Kernohan Neil, Li Chunhui, Nabi Ghulam
Division of Imaging Sciences and Technology, School of Medicine, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, UK.
Radiology Department, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia.
Cancers (Basel). 2024 Nov 28;16(23):3995. doi: 10.3390/cancers16233995.
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. : 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 < 0.05. : 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. : 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.
前列腺癌是西方国家老年男性中第二常见的癌症。经直肠超声引导下前列腺穿刺活检（TRUS活检）仍是前列腺癌的标准诊断方法，但存在显著风险，尤其是在老年男性中，包括败血症、急性尿潴留和直肠出血等并发症，这些并发症可导致严重的发病率和死亡率。本研究旨在评估80岁以上男性的癌症特异性生存结果，以及TRUS活检程序是否具有任何癌症特异性生存优势。：2005年1月至2015年12月，我们研究了200例前列腺特异性抗原（PSA）水平升高（>4.0 ng/mL）和/或直肠指检（DRE）异常的患者（中位年龄82岁）的TRUS活检结果。在一个特定地理区域内，使用电子系统和唯一标识符对每位参与者进行随访直至死亡。使用SPSS进行癌症特异性和总体生存分析，同时使用R项目构建和评估两个生存时间列线图，并预测活检后死亡风险。所有统计检验均为双侧检验，显著性设定为<0.05。：在参与者中，随访结束时仅有24例患者存活（中位年龄91岁）。PSA水平范围为4.88至102.7 ng/mL。对数秩检验和Breslow检验表明，较高的PSA水平转移的发生以及国际泌尿病理学会（ISUP）分级8-10组与较短的生存时间相关。由于年龄、合并症和肿瘤类型具有临床意义，因此将其纳入列线图。年龄<81岁的患者死亡风险较低，而年龄>88岁的患者面临较高的死亡风险。活检并发症在癌症和良性病例中均增加了死亡风险，转移显著增加了死亡可能性。然而，合并症并未影响生存概率。：我们的研究结果强调，高龄（特别是80岁及以上）、高Gleason评分、转移和PSA水平升高可预测老年男性TRUS活检后较差的生存结果。
