Elevated PSA

What is the DRE?
The DRE or digital (finger) rectal examination is a quick exam for checking the health of the prostate. For this test, the doctor inserts a gloved and lubricated finger into the rectum. This allows the doctor to feel the back portion of the prostate for size and any irregular or abnormally firm areas.

How accurate are the screening tests?
No test is right all the time, and that is true of the PSA test and DRE. The PSA test is better at suggesting that small cancers are present, especially those toward the front or sides of the prostate gland, or deep within it. But the DRE can sometimes help suggest cancers in men with normal PSA levels. That is why both the PSA test and the DRE are usually performed.
If 100 men over age 50 take the PSA test,
85 will have a normal PSA (though a small number of these men will have a cancer that was missed by the PSA test).
15 will have a higher than normal PSA and require further tests.

After further testing, results will show
12 do not have prostate cancer.
3 have prostate cancer.

What do medical experts say about screening?
Medical experts agree that every man needs balanced information on the pros and cons of prostate cancer screening to help him make an informed decision. Balanced information is important because medical experts disagree about whether men should be screened regularly for prostate cancer.

Medical experts who encourage regular screening believe current scientific evidence shows that finding and treating prostate cancer early, when treatment might be more effective, may save lives. They recommend that all men who have a life expectancy of at least 10 years should be offered the PSA test and DRE annually beginning at age 50. They also recommend offering screening tests earlier to African-American men, and men who have a father or brother with prostate cancer.

Medical experts who do not recommend regular screening want convincing evidence that finding early-stage prostate cancer, and treating it, saves lives. They believe some of these cancers may never affect a man’s health, and treating them could cause temporary or long-lasting side effects like impotence (inability to keep an erection) and incontinence (inability to control the urine flow, resulting in leakage or dribbling). Because they believe it is unclear if the potential benefits of screening outweigh the known side effects of treatment, they recommend that all men be given information on the pros and cons of screening before making their own screening decision

Blood test for prostate-specific antigen (PSA): A lab checks the level of PSA in your blood sample.
The prostate makes PSA. A high PSA level is commonly caused by BPH or prostatitis (inflammation of the prostate). Prostate cancer may also cause a high PSA level. The digital rectal exam and PSA test can detect a problem in the prostate. However, they can’t show whether the problem is cancer or a less serious condition. If you have abnormal test results, your doctor may suggest other tests to make a diagnosis. All, or none, of these tests may be ordered by your doctor: Free PSA: In the bloodstream, some of the PSA is bound to proteins and some is not. The percent of PSA that is not bound to proteins (free PSA) may help to determine if an abnormal PSA is more likely to be elevated due to benign enlargement of the prostate (BPH) or due to cancer.