Tests that examine the prostate and blood are used to detect prostate cancer.
After the age of 50, all men should have yearly examinations of both the prostate and PSA. Any man with a first line blood relative (father or brother) with prostate cancer, and all African-American men should begin their initial screening at age 40.
- Digital rectal exam (DRE): During this examination, a doctor inserts a gloved, lubricated finger into the rectum to feel for any irregular or abnormally firm area that might be cancer. The prostate gland is located just in front of the rectum, and most cancers begin in the back part of the gland that can be reached by a rectal exam. While it is uncomfortable, the exam causes no pain and only takes a short time.
- Prostate-specific antigen (PSA) test: During the 1980s, the Prostate Specific Antigen (PSA) blood test was developed. Testing a blood sample for the amount of PSA now plays an important part in the early detection of prostate cancer. Most men that present to our office (60-70 percent) have their prostate cancer diagnosed using only an elevated PSA and a normal DRE. If an abnormally high level of PSA is detected in the blood, prostate cancer is a possibility. However, a high PSA score does not always indicate cancer and can be caused by other prostate diseases such as benign prostatic hypertrophy (BPH) or prostatitis (inflammation of the prostate).
Based on the patient’s age, certain PSA cutoff values are considered high. It is well know that our PSA will also normally go up slowly as we age, even if there is no prostate abnormality. The rate of PSA change (PSA velocity) is also very valuable in prostate cancer screening. As such, you should keep a record of all your PSA values. Most men have blood levels under 4 nanograms per milliliter (ng/mL). When prostate cancer develops, the PSA level often rises above 4 ng/mL. If your level is above 4 but less than 10, you have about a 25 percent chance of having prostate cancer on biopsy. If your PSA is above 10 ng/mL, your chance of having prostate cancer is over 50 percent and increases as your PSA level increases.
Age-adjusted PSA-cut-off values have been well described to compensate for the natural rise in values related to age and normal prostate growth.
Since ejaculation can cause a temporary increase in blood PSA levels, some doctors will
Age-related "normal" PSA cut-points
Age Range (years)
Serum PSA Concentration (µg/L)
40 - 49
50 - 59
60 - 69
70 - 79
Oesterling JE et al. JAMA 1993; 270:860
suggest that men abstain from
ejaculation for two days before testing. Several medicines and herbal
preparations can lower blood PSA levels. You should tell your doctor if
you are taking 5-alpha reductase medications for BPH (Proscar, Propecia
While the PSA test is considered controversial because of the risk of
"false-positives" that may lead to unnecessary follow up tests and
procedures, it is currently the only test that gives the medical
community the ability to diagnose prostate cancer at its earliest stages
– while it is still confined to the prostate (localized) and has not
spread (metastatic). Read more about the PSA test.