Testing and Monitoring for Prostate Cancer

This content has been reviewed and approved by

Daniel P. Petrylak, MD
Associate Professor of Medicine
Director, Genitourinary Oncology Program
Columbia University Medical Center

There is no standard or routine screening test for prostate cancer like there is for breast cancer (mammogram) or colon cancer (colonoscopy and other similar tests). One reason is that while studies find that screening can detect prostate cancer at an early stage, there's no clear evidence that this detection reduces deaths from prostate cancer. Thus, it is up to the physician and patient to evaluate the potential pluses and minuses when deciding on prostate cancer screening.

Two tests are commonly used for prostate screening:  

DRE (digital rectal examination) -A physician or nurse places a gloved lubricated finger into the rectum to examine the rectum and feel the prostate gland. As recommended by your physician, DREs are usually conducted annually for men over the age of 50.

PSA (prostate-specific antigen) -PSA is a blood test that measures the level of prostate specific antigen. PSA is a substance produced by the prostate gland, which may be found in higher amounts in men who have prostate cancer. As recommended by your physician, the PSA test may be performed annually for men over the age of 50.

Men in high-risk groups, such as African-Americans or those with a strong family history of prostate cancer, should consult their physicians regarding when they should begin having these tests, and how often they should be conducted. 

Additional Procedures/Exams to Identify Prostate Cancer

If the results of the DRE or PSA are unusual, your physician may repeat DRE or PSA tests or request other procedures. These evaluation tools may include:

• Transrectalultrasound (TRUS) -Thistest uses sound wave echoes to create an image of the prostate gland to visually inspect for abnormal conditions. A transrectal ultrasound image can show enlargement of the prostate gland and detect abnormal growth in or around the prostate. Ultrasound may also be used to guide a needle to obtain a biopsy of the prostate gland and/or to guide the nitrogen probes in cryosurgery.
• Computed tomography scan (also called a CT or CAT scan) - CT isa diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard x-rays.
• Magnetic resonance imaging (MRI) -MRIusesacombination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Radionuclide bone scan -This scanisanuclear imaging method that helps to detect any cancer that has spread from the prostate gland to bones. The test involves injecting a radioactive dye into a vein that can be seen on the image of diseased bone cells throughout the entire body.
• Biopsy (lymph node and/or prostate) -A biopsy isa procedure that removes tissue samples from the prostate (with a needle or during surgery). The samples are examined under a microscope for the presence of cancer cells or other abnormal cells.The diagnosis of cancer is confirmed only by a biopsy. Once prostate cancer is diagnosed, two determinations are made: the stage of the cancer and the grade of the cancer.