The purpose of screening is early diagnosis and treatment. Screening tests are administered to people without current symptoms, but who may be at high risk for certain diseases or conditions.

Since the 1990s when screening for prostate cancer with digital rectal exam and the blood test PSA began, many more cases of prostate cancer have been diagnosed and the death rate from prostate cancer has decreased. However, doctors are still unsure if these trends are a direct result of the screening methods.

The American Urological Association and American Cancer Society recommend screening for all men age 50 and older. However, there is still debate as to whether or not the benefits of screening for prostate cancer outweigh its potential harms. The US Preventive Services Task Force of the Public Health Service, for example, concludes that there is not enough research evidence to make this determination. Until more is known, the best course of action is to speak to your doctor or urologist about your own personal risks, especially if you're between the ages of 50-75, when PSA-based screening is likely to be most beneficial.

Screening Tests

Two tests are routinely used to screen for prostate cancer:

Digital Rectal Exam

A digital rectal exam is done in your doctor’s office, often as part of a routine physical exam. The doctor inserts one gloved and lubricated finger into the rectum and feels the contours of your prostate through the rectal wall. You should not feel pain during the exam, but you may feel slight pressure. You also may feel a bit nervous or anxious; take slow, deep breaths to help yourself relax. If there is a tumor in the prostate gland and it is large enough, the doctor may be able to feel it. However, some cancers may be so small that they cannot be felt on examination.

Prostate Specific Antigen (PSA) Test

This test measures the levels of PSA in your blood. PSA is a chemical produced in the prostate gland and released into the bloodstream. Prostate cancer, with its overabundance of rapidly dividing prostate cells, tends to considerably increase PSA levels. Unfortunately, an elevation in PSA levels may also occur as a result of other conditions, including:

  • Benign prostatic hypertrophy—a very common condition of prostate enlargement in older men
  • Inflammation of the prostate (called prostatitis)
  • Ejaculation—Your doctor may ask you to abstain from sexual activity for two days before the test.

Therefore, if your PSA is elevated, it does not necessarily mean you have cancer. Depending on your PSA level, physical examination and risk factors, your doctor may suggest one of several options, including:

  • Repeating the test at a later date
  • Improving the test's accuracy through specialized laboratory measurements (eg, free PSA, PSA velocity, and PSA density
  • Obtaining biopsies of the prostate gland to determine if cancer is present