Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies

Abstract

Introduction:Despite the well-known findings related to malignity in DRE such as nodule and induration, asymmetry of prostatic lobes, seen relatively, were investigated in a few studies as a predictor of prostate cancer so that there is no universally expected conclusion about asymmetry. We aimed to compare cancer detection rate of normal, asymmetric or suspicious findings in DRE by using biopsy results.Materials and Methods:Data of 1495 patients underwent prostate biopsy between 2006-2014 were searched retrospectively. Biopsy indications were abnormal DRE and or elevated PSA level(>4ng/mL). DRE findings were recorded as Group 1: Benign DRE, Group 2: Asymmetry and Group 3: Nodule/induration. Age, prostatic volume, biopsy results and PSA levels were recorded.Results:Mean age, prostate volume and PSA level were 66.72, 55.98 cc and 18.61ng/ mL respectively. Overall cancer detection rate was 38.66 % (575 of 1495). PSA levels were similar in group 1 and 2 but significantly higher in group 3. Prostatic volume was similar in group 1 and 2 and significantly lower in Group 3.Malignity detection rate of group 1,2 and 3 were 28.93%, 34.89% and 55.99% respectively. Group 1 and 2 were similar (p=0.105) but 3 had more chance for cancer detection.Conclusion:Nodule is the most important finding in DRE for cancer detection. Only an asymmetric prostate itself does not mean malignity.

Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis

“…The latter may be partly explained by the lack of a universal definition for an abnormal DRE. 29 These limitations, the paucity of published data, and the lack of high-quality randomized controlled trials on this topic make it difficult to interpret the results of our meta-analysis and decrease the reliability of our findings. Finally, for ethical reasons, only patients with a positive DRE or elevated PSA level underwent a biopsy, potentially underestimating the false-negative rate, and thus overestimating the sensitivity and NPV of DRE.…”

Digital Rectal Examination for Prostate Cancer

“…An asymmetric prostate itself cannot be accepted as a cancer sign. Some additional studies may be useful to come to an exact conclusion about asymmetry in the prostate [8]. PSA as a screening tool has contributed to the early detection of prostate cancer.…”