Screening is a way to evaluate people without symptoms to determine if they are at risk for cancer or have already developed cancer.

Since the 1990s, when screening for prostate cancer with the digital rectal exam and the PSA blood test 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.

Screening Guidelines

Current recommendations from the American Cancer Society, the American Urological Association, and the American College of Radiology recommend yearly digital rectal exam and PSA test for men over the age of 50. African-American men and men with a positive family history of prostate cancer (for example, a father or brother with prostate cancer) should consider beginning these annual screenings at age 40.

Many medical professional organizations do not recommend routine screening for prostate cancer for all men. Instead, they suggest the decision to screen should be based on your risk factors and discussion with your doctor—especially for men between the ages of 50 and 65.

Screening Tests

Digital rectal exam (DRE) – this test is performed in your doctor’s office, often as part of a routine physical exam. The doctor inserts one gloved, lubricated finger into the rectum and feels the contours of the prostate through the rectal wall. During this exam, your doctor is trying to evaluate the size of your prostate gland, whether it’s enlarged, whether it has any bumps or ridges, and whether its texture feels normal or hard. 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.

Prostate specific antigen (PSA) test – a measurement of PSA levels in your blood. PSA is a chemical produced in the prostate gland and released into the bloodstream. When the prostate gland is enlarged, the level of PSA released is increased. The level of PSA also increases as you get older and after sexual activity. Therefore, your doctor may ask you to abstain from sexual activity for two days before the test. Your PSA level may also be increased if your blood is tested directly following a digital rectal exam; it’s a good idea to have your blood drawn for this test before your physical exam. Doctors sometimes look at specialized laboratory measurements of the PSA called percent-free PSA, PSA velocity, and PSA density.