Volume 27, Issue 138, August 2023

Prostate cancer severity prediction in advanced age groups in low incidence region

Mostafa A Arafa^1,2, Karim H Farhat^1♦, Danny M Rabah^1,3,4, Alaa Mokhtar⁴, Waleed Al-Taweel⁴, Alanoud Abdullah Albukairi⁵, Mohamed Fawzi Farahat^2,6, Horeya M Ismail²

¹The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
²Department of Epidemiology, High Institute of Public Health, Alexandria University, Egypt
³Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
⁴Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
⁵Medical Student, College of Medicine, King Faisal University, Riyadh, Saudi Arabia
⁶Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia

^♦Corresponding author
The Cancer Research Chair, College of Medicine, King Saud University, Riyadh, KSA

ABSTRACT

Objectives: To explore the relationship between prostate cancer (PCa) aggressiveness and the advanced age at diagnosis. Materials and methods: Men who had high Prostate-specific antigen (PSA) (>4ng/ml) were referred to the urology clinic for further evaluation by MRI, and those with positive findings were scheduled for a biopsy. Depending on its size, a systematic 12-core procedure was employed in each patient, following the extraction of 2-6 cores from the identified lesion. Non-significant prostate cancer had a Gleason score (GS) lower than 3 + 4, whereas significant PCa was categorized as having a GS of 3 + 4 or higher. Results: Out of all screened 6482 cases, 75 were diagnosed as clinically significant cancer (CSC) cases, and 21 were non-clinically significant. Age was significantly correlated with CSC in univariate analysis, where the percentage of CSC cases increased with increased age categories, and it was a significant independent predictor in all multivariate models. Its discriminative ability is high (AUC=0.75). The percentage of CSC cases (63.6%) is significantly higher in the smallest volume category (≤33 cc) in comparison to the 34-60 cc category (29.5%) and >60 cc category (31.8%). The interaction parameter, age-prostate volume, was a significant independent predictor of CSC, particularly for the smaller prostate volume (<33 cc). Conclusions: Age is considered a significant independent predictor of CSC, in general, and for older men in specific. The ability of prostate size to detect CSC becomes higher when interacting with age, particularly for small prostate size.

Keywords: Prostate cancer, Aggressiveness, Advanced age, Low incidence countries, Saudi Arabia

Medical Science, 2023, 27, e331ms3168

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DOI: https://doi.org/10.54905/disssi/v27i138/e331ms3168

Published: 09 August 2023