OBJECTIVE: To investigate the relationships between 2nd to 4th digit ratio 
(digit ratio) and prostate cancer detection rate and biopsy findings, including 
Gleason score.
MATERIALS AND METHODS: In 770 consecutive men aged 40 years or older that 
presented with lower urinary tract symptoms (LUTS), right hand 2nd and 4th digit 
lengths were measured prior to PSA determinations, DRE and transrectal 
ultrasonography (TRUS). Among these, 166 men with a prostate specific antigen 
(PSA) level ≥ 3 ng/mL or abnormal digit rectal examination (DRE) prospectively 
underwent prostate biopsies. The relationship between digit ratio and prostate 
cancer detection rate and biopsy findings was investigated.
RESULTS: The study subjects were allocated to two groups by digit ratio (group 
A: digit ratio < 0.95; n = 420; group B: digit ratio ≥ 0.95; n = 350). Despite 
similar biopsy rates (22.4% vs. 20.6%, p = 0.544), group A had higher cancer 
detection rate (46.8% (44/94) vs. 23.6% (17/72), p = 0.002; OR = 2.847, 95% CI = 
1.445-5.610). When we analyzed 408 positive biopsy cores (group A: digit ratio < 
0.95, n = 282; group B: digit ratio ≥ 0.95, n = 126), group A had higher 
percentage of core cancer volume (46.7% vs. 37.1%, p = 0.005) and more biopsy 
cores with high Gleason score (sum of Gleason score ≥ 9: 18/282 (6.4%) vs. 1/126 
(0.8%), p = 0.010; primary Gleason score = 5: 12/282 (4.3%) vs. 0/126 (0.0%), p 
= 0.021).
CONCLUSIONS: A lower digit ratio is related to an increased detection rate of 
prostate cancer, a high percentage of core cancer volume and a high Gleason 
score.