Prostate Exams: Diagnostic Testing

Prostate cancer can occur in any man, but there are certain “risk groups.” Younger African American men appear to have twice the risk and fatalities of Caucasians. Sadly, many are diagnosed before they reach the age of 50.

Another risk group is men who have a family history of prostate cancer, placing them in the same group who may contract the disease before the age of 50.

The only method to determine whether you are at risk for prostate cancer is diagnostic testing. The earlier you are screened the higher your chances of survival. Let’s explore some of the diagnostic options.

Digital Rectal Exam (DRE)

Testing begins with a digital rectal exam (DRE). This examination has been the benchmark for discovering cancer as well as BPH. Your doctor can determine the condition and size of the prostate by inserting a gloved finger into the rectum.

Prostate Specific Antigen (PSA)

In the mid-1980s’ the FDA approved the use of monitoring blood levels for prostate specific antigen (PSA). At that time, this was considered a major breakthrough in the diagnosis and treatment for prostate cancer.

Here’s why. PSA readings specifically target prostate cells. A healthy prostate gland produces a constant level, usually 4 nanograms per milliliter which is considered as a PSA reading of “4” or less.

Cancer cells produce growing amounts that escalate. They correlate with the severity of cancer. A PSA level greater than 4 will give the doctor some cause for investigation. If the level reaches 10 he will have cause to consider the presence of prostate cancer. An amount over 50 may indicate that the cancer has spread to other parts of the body.

A PSA test usually measures the total amount that is attached to blood proteins. However, later research gained an FDA approval for a test called the Tandem R test. This test also gives a measure of the total PSA and reads another component called free PSA. Free PSA floats unbound in blood.

Have these two tests to compare helps to rule out prostate cancer in men whose PSA is just mildly elevated due to other causes. A 1995 study in the Journal of the American Medical Association shows that a free PSA test reduces unnecessary prostate biopsies by 20% in certain patients whose PSA is between 4 and 10.

As newer sophisticated methods are made available, it is creating a controversy among the healthcare community regarding “when” men should be screened, how often and whether to screen men under 50 with no symptoms.

Some are saying that mass screening is expensive while others point out reductions in mortality rates when early screening diagnoses prostate cancer. The jury is still somewhat “out” on that debate, but it never hurts to err on the side of caution. It is your body, after all!

It should be noted that both The American Urological Association and The American Cancer Society recommend annual PSA test for all men over 50 and for those at high risk over 40.

Take the case of Joe. A healthy, 36 year old, robust father of two was required to take a routine physical exam for his work-related insurance. During this exam, his doctor noted that his prostate was enlarged. Unfortunately, the resulting tests proved that he did indeed have prostate cancer. Further investigation revealed that he was “at risk” based on family history.

Why take chances? Get yourself screened so you have a benchmark, then having annual screening. Remember, prostate cancer is slow growing so the odds are in your favor when detected early.

Urine Test

A standard urine test can also help to diagnose prostate problems by screening for blood or infection. The chemical tests will also check for liver, diabetes or kidney disease.

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