ObjectivesTo 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 methodsFrom 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.ResultsA 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.ConclusionIn 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.

中文翻译：

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患者年龄和高级别前列腺癌在 MRI 可疑病变靶向活检中的相互作用

目的 评估患者年龄和前列腺成像报告和数据系统 (PI-RADS) 评分在确定老年男性磁共振成像 (MRI) 靶向活检中确定的前列腺癌 (PCa) 分级方面的相互作用。这项前瞻性累积机构审查委员会批准的 2012 年 6 月至 2022 年 12 月期间 MRI 靶向和系统活检比较研究，选择了活检前 MRI 上至少有一个 PI-RADS ≥3 病变且既往无 PCa 病史的男性。进行序数和二项逻辑回归分析。结果共有 2677 名男性符合研究标准。最高 PI‐RADS 评分为 1220 名男性中的 3 分 (46%)、950 名男性中的 4 分 (36%)、507 名男性中的 5 分 (19%)。患者年龄中位（四分位距 [IQR]）为 66.7 (60.8–71.8) 岁，前列腺特异性抗原 (PSA) 水平中位 (IQR) 为 6.1 (4.6–9.0) ng/mL，前列腺体积中位 (IQR) 为48 (34–68) mL，中位 (IQR) PSA 密度为 0.13 (0.08–0.20) ng/mL/mL。通过靶向活检分别在 1264 名 (47%) 和 321 名 (12%) 男性中发现了具有临床意义的 (cs)PCa 和高风险 PCa。老年组中 csPCa 和高危 PCa 的患病率显着较高。在多变量分析中，患者年龄与 csPCa 显着相关，但与高危 PCa 无关； PI-RADS 评分以及年龄和 PI-RADS 评分的交互作用与高危 PCa 显着相关，但与 csPCa 无关。结论在我们的队列中，老年男性 MRI-超声融合靶向活检中高危 PCa 的发生率很高，并且它与 MRI 结果的显着相关性支持了活检前 MRI 定位疾病的价值，这些疾病甚至在老年男性中也可能导致癌症死亡。