Interaction of patient age and high‐grade prostate cancer on targeted biopsies of MRI suspicious lesions

Objectives To evaluate 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. Patients and methods From a prospectively accrued Institutional Review Board‐approved comparative study of MRI‐targeted and systematic biopsy between June 2012 and December 2022, men with at least one PI‐RADS ≥3 lesion on pre‐biopsy MRI and no prior history of PCa were selected. Ordinal and binomial logistic regression analyses were performed. Results A total of 2677 men met study criteria. The highest PI‐RADS score was 3 in 1220 men (46%), 4 in 950 men (36%), and 5 in 507 men (19%). The median (interquartile range IQR) patient age was 66.7 (60.8–71.8) years, median (IQR) prostate‐specific antigen (PSA) level was 6.1 (4.6–9.0) ng/mL, median (IQR) prostate volume was 48 (34–68) mL, and median (IQR) PSA density was 0.13 (0.08–0.20) ng/mL/mL. Clinically significant (cs)PCa and high‐risk PCa were identified on targeted biopsy in 1264 (47%) and 321 (12%) men, respectively. Prevalence of csPCa and high‐risk PCa were significantly higher in the 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. Conclusion In our cohort, the substantial rate of high‐risk PCa on MRI–ultrasound fusion targeted biopsies in older men, and its significant association with MRI findings, supports the value of pre‐biopsy MRI to localise disease that could cause cancer mortality even in older men.