Prostate cancer screening in a geriatric population.

Abstract

317 Background: PSA screening often results in diagnosis of clinically nonsignificant prostate cancer, which may lead to unnecessary treatment especially in the geriatric population. The best practice for screening this population remains controversial. Methods: We conducted a retrospective observational analysis of men referred by their primary care provider to the PSA clinic at Banner Gateway MDACC from 2022 to 2024. Diagnostic work-up was managed by urologic oncology specialists and incorporated routine pre-biopsy 3.0T contrast-enhanced prostate MRI. Inclusion criteria were abnormal PSA per referring physician without other symptoms of or a history of prostate cancer. Patients were divided into geriatric (age ≥75) and nongeriatric (age <75) groups. Bivariate analysis was performed, using t-tests or Mann–Whitney U tests for continuous variables and Chi-square or Fisher’s exact tests for categorical variables, as appropriate. Results: A total of 533 subjects were included. The median PSA was 5.8 ng/mL (IQR 4.6-8.1), with a higher median PSA observed in the geriatric group (6.8 ng/mL, IQR 5.3-11.4) than in younger patients (5.5 ng/mL, IQR 4.4-7.5; p < 0.001). Locally assessed PI-RADS scores were categorized into three groups: 0–2, 3, and 4–5. MRI was performed in 401 patients (75.2%) and biopsy in 264 patients (49.5%), with no significant differences between age groups. There was a trend toward a higher proportion of PI-RADS 4-5 lesions in the geriatric population compared with younger patients (58.6% vs. 47.6%), though this did not reach statistical significance (p = 0.19). Prostate cancer was diagnosed in 186 patients (34.9% of the cohort). The proportion of biopsies yielding a cancer diagnosis was significantly higher in the geriatric group (88.5% vs. 65.0% p < 0.001), corresponding to a positive biopsy odds ratio of 4.15 (95% CI 1.79-9.6). 36 patients (19.3%) had Gleason grade 1, and 151 patients (80.7%) had Gleason grade ≥2. The distribution of Gleason scores did not differ significantly by age group. Conclusions: Prostate cancer screening in a cancer center setting incorporating routine pre-biopsy prostate MRI resulted in a high detection rate of clinically significant prostate cancers in geriatric men. This suggests that screening in the geriatric population can be appropriate, with a low rate of negative or clinically non-significant prostate cancer diagnoses minimizing unnecessary biopsies and overtreatment risk. Screening outcomes by age group. Overall (n=533) Age <75 (n=415) Age ≥75 (n=118) p-value Median PSA (IQR) 5.8 (4.6-8.1) 5.5 (4.4-7.5) 6.8 (5.3-11.4) <0.001 MRI, n (%) 401 (75.2%) 314 (75.7%) 87 (73.7%) 0.67 PI-RADS 0-2 91 (22.9%) 75 (24.1%) 16 (18.4%) PI-RADS 3 108 (27.1%) 88 (28.3%) 20 (23.0%) PI-RADS 4-5 199 (50.0%) 148 (47.6%) 51 (58.6%) Biopsy, n (%) 264 (49.5%) 203 (48.9%) 61 (51.7%) 0.59 Prostate cancer 186 (70.5%) 132 (65.0%) 54 (88.5%) <0.001 GG 1 36 (19.3%) 29 (22.0%) 7 (12.7%) 0.14 GG ≥ 2 151 (80.7%) 103 (78.0%) 48 (87.3%) 0.14