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Avatar universal

Do I really need to have a prostate biopsy?

My GP referred me to a urologist after the DRE, even though my PSA was normal.
The urologist performed the the DRE and announced I had an asymmetrical prostate - one side lobe is larger than the other.  He said even though my PSA test was normal I could still have prostate cancer.  I'm 65, with no recent change of symptoms.  Is there a significant chance I have cancer with this situation?  Are the doctors just being super cautious?  Is it dangerous for me to just refuse the biopsy and monitor my condition via regular PSA tests?  Thanks for your help.
3 Responses
20620809 tn?1504362969
This was posted a while ago. Any updates? I have tried to read about asymmetrical prostates and what I've gathered from my informal research is that it is common and not necessarily linked to prostate cancer. https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1464-410X.1997.00155.x  I would guess they are being cautious and want to evaluate further.  I personally would work with your doctor and do as they recommend, however, if you are not confident in the first doctor's findings or recommendations, get a second opinion.  Let me know how this went down since it has been a few weeks.
Here's one that's more recent (2016), from Brazil. Like the one you cite (by Hansen), it's inconclusive. "Although the patients with asymmetry had somewhat more cancer detection rate than benign DRE, the difference could not reach a statistically significant level, therefore, as Hansen et al. did, we also concluded that asymmetry does not carry significant additional risk for prostate cancer."

Or, we can look another way at the data and say that of all those who got a biopsy because of asymmetry, ~35% had PCa.

"Does an asymmetric lobe in digital rectal examination include any risk for prostate cancer? results of 1495 biopsies"
I’m going to stick by my original recommendation that if there’s ANY indication of even POSSIBLE prostate cancer, ask your Dr/Urologist for a PHI test. It’s WAY more accurate & predictive for PCa than either the PSA, DRE or both. I had the opposite situation - high PSA but multiple DREs (including the one by a Urologist whose specialty was Prostate Cancer & Surgery) were negative. I’m opposed to dropping either PSA testing or DREs - my advice is, continue w/ BOTH, and if EITHER one or the other other (or both) shows any indication, then proceed directly to the PHI (Prostate Health Index) or other similar tests that are much more predictive than either PSA or DRE. In my case, because the DRE didn’t indicate anything, I waited too long to address it, and my surgery wasn’t able to get all the cancer because it had already spread outside the gland. If PCa is caught early, it’s virtually 100% curable. Caught too late, like mine, and I’m very likely headed for eventual metastasis into the bones, a very grim situation...
Avatar universal
I just answered another Q here on MedHelp re: whether to do a biopsy. I’m a prostate cancer patient myself, had surgery last yr (07/31/18). I had a high PSA, didn’t want to do a biopsy unless there was a very strong chance I had cancer (my DRE found nothing unusual) so I requested a PHI test = Prostate Health Index, it’s a simple blood test that is WAY more accurate than PSA alone. It measures PSA along w/ 2 other factors & the 3 together generate a number. Under 24 means  50% chance of cancer. SkipNBeat, I don’t know whether you’ve already had the biopsy, but if not, ask your Dr. for this test 1st, then if your # puts you at risk, go ahead w/ the biopsy. In my case, my # came back at 68, which meant I was at very high risk, so I did the biopsy, which confirmed the cancer. I don’t know why Dr’s don’t routinely order this whenever Prostate cancer is suspected - it’s quick, non-invasive & way less expensive than either a biopsy or MRI. If you have not already had the biopsy, please insist on PHI 1st, then the biopsy if you’re at high risk...
1081992 tn?1389903637
Here's an eye opener, at least to me, from McMaster in Canada.

--Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis-- 2018

"Recommendations regarding prostate cancer screening have been inconsistent. The Canadian Urological Association recommends screening with both DRE and PSA in all average-risk men aged 50 years and older with a minimum life expectancy of 10 years. In contrast, the Canadian Task Force on Preventive Health Care recommends against use of the PSA test for prostate cancer screening in men aged 55 years or older without a previous diagnosis of prostate cancer."

Their CONCLUSION: "Given the considerable lack of evidence supporting its efficacy, we recommend against routine performance of DRE to screen for prostate cancer in the primary care setting."
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