PROSTATIC ASYMMETRY AS A RISK FACTOR FOR PROSTATIC-CARCINOMA - SERIALPROSTATE-SPECIFIC ANTIGEN MONITORING AND CANCER-DETECTION

Objective To compare the rates of cancer detection in men with a norma l, asymmetric, or suspicious prostate on digital rectal examination(DR E) initially and after 3 years of serial monitoring of prostate specif ic antigen (PSA) level. Patients and methods Prostatic 'asymmetry' was defined as asymmetric growth of the lateral lobes of the prostate wit hout induration or nodules, as assessed by a DRE. The study included 9 63 men with no clinical evidence of prostate cancer and whose serum PS A levels were monitored at 4 month intervals. Prostatic biopsy was rec ommended if the PSA level became persistently abnormal (>4-ng/mL) or i ncreased by >20% after having been initially abnormal. Cancer detectio n rates were compared among groups categorized by the initial DRE find ings and serum PSA level. Results On comparing groups with suspicious and normal DREs, and abnormal with normal PSA levels both, as expected , were associated with a statistically significant increase in cancer detection. However, an asymmetric prostate did not carry an increased risk of detecting prostate cancer when compared with a normal prostate , regardless of PSA level. Conclusions An asymmetric prostate does not appear to be an independent risk factor for detecting prostate cancer . Therefore, an asymmetric prostate with no abnormality in PSA level s hould not mandate prostatic biopsy, or even an increase in monitoring frequency above the presently recommended annual interval.