The purpose of screening is early diagnosis and treatment. Screening tests are usually 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, other medical professional organizations do not recommend routine screening of 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. This debate over PSA-based screening will likely take many years to mature; in the meantime, you should discuss your specific issues with your primary care doctor or urologist.

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 physician 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. 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.

Doctors sometimes look at specialized laboratory measurements of the PSA called percent-free PSA, PSA velocity, and PSA density. Although the PSA test is highly specific for prostate cancer, it is not totally diagnostic in itself. Elevations of PSA may also occur as a result of inflammation of the prostate and after ejaculation. If your PSA is elevated, your doctor may suggest either that the test be repeated or that additional testing, particularly a biopsy, be done to determine whether a cancer is present.