What is it about?

The study aimed to evaluate the impact of patient age and Prostate Imaging-Reporting and Data System (PI-RADS) score on the grade of prostate cancer (PCa) identified on magnetic resonance imaging (MRI)-targeted biopsy in older men. A total of 2677 men with at least one PI-RADS ≥3 lesion on pre-biopsy MRI and no prior history of PCa were selected. The results showed that the highest PI-RADS score was 3 in 1220 men (46%), 4 in 950 men (36%), and 5 in 507 men (19%). The median patient age was 66.7 years, and the median PSA level was 6.1 ng/mL. Clinically significant (cs)PCa and high-risk PCa were identified on targeted biopsy in 1264 (47%) and 321 (12%) men, respectively. The prevalence of csPCa and high-risk PCa were significantly higher in older age groups. On multivariable analyses, patient age was significantly associated with csPCa but not high-risk PCa; PI-RADS score and the interaction of age and PI-RADS score were significantly associated with high-risk PCa but not csPCa. The study highlights the importance of pre-biopsy MRI to detect high-risk PCa in older men, as it could cause cancer mortality even in older men.

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Why is it important?

This research is important as it evaluates the interaction of patient age and Prostate Imaging-Reporting and Data System (PI-RADS) score in determining the grade of prostate cancer (PCa) identified on magnetic resonance imaging (MRI)-targeted biopsy in older men. It provides valuable insights into the role of pre-biopsy MRI in detecting high-risk PCa, particularly in older men, who are more likely to be diagnosed with PCa and have more aggressive disease at diagnosis. This research can help in identifying men who may benefit from early diagnosis and treatment of high-risk PCa, potentially improving outcomes and reducing mortality rates. Key Takeaways: 1. The study found that the substantial rate of high-risk PCa on MRI-ultrasound fusion targeted biopsies in older men supports the value of pre-biopsy MRI to localize disease that could cause cancer mortality even in older men. 2. Patient age was significantly associated with clinically significant (cs)PCa but not high-risk PCa; PI-RADS score and the interaction of age and PI-RADS score were significantly associated with high-risk PCa but not csPCa. 3. The ability of pre-biopsy MRI to detect high-risk PCa in particular is relevant, especially in older men with no significant competing risk factors for mortality. 4. The PPV of PI-RADS 4 and 5 for high-risk PCa was higher in older men, likely influenced by the higher prevalence of aggressive disease with older age.

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This page is a summary of: Interaction of patient age and high‐grade prostate cancer on targeted biopsies of MRI suspicious lesions, BJU International, March 2024, Wiley,
DOI: 10.1111/bju.16341.
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