Screening Tests

Digital Rectal Exam

A digital rectal exam is done in your doctor’s office, often as part of a routine physical exam. However, it is not routinely used to screen patients for prostate cancer. 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 during this exam.

Prostate Specific Antigen (PSA) Test

Using the PSA test as a screening tool is a controversial topic. The US Preventative Services Task Force (USPSTF) and the American Academy of Family Physicians do not recommend this test due to the potential harms outweighing the benefits. The American Cancer Society (ACS) recommends that men talk to their doctors about the benefits and risks of the PSA test. The USPSTF also points out the importance of discussing this screening test with your doctor.

The PSA 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 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 exam, and risk factors, your doctor may suggest one of several options, including:

  • Repeating the test at a later date
  • Ordering other tests (such as, free PSA, PSA velocity, and PSA density)
  • Doing a biopsy of the prostate gland to determine if cancer is present