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Prostate cancer is now the most commonly diagnosed malignancy in men (excluding skin cancer) with over 300,000 new cases diagnosed in 1996 in the United States alone. It remains second only to lung cancer as the leading cancer killer among men. Having learned from the breast cancer movement of the last two decades, widespread media attention has put prostate cancer into magazines, newspapers as well as onto TV talk shows and soap-operas. Controversies regarding the diagnosis and treatment of prostate cancer can be confusing and frustrating for men facing prostate cancer as well as their families.

Diagnosing prostate cancer today continues to use the combination of digital rectal exam and serum PSA testing.

Rectal Exam- Since the prostate lies on top of the rectum in the deep pelvis, a digital rectal exam allows the physician to feel the posterior surface of the prostate gland where over 90% of cancers develop. It also provides important information regarding the extent of the cancer present and the possibility of spread outside the prostate.

Prostate Specific Antigen (PSA)- PSA is a protein made by both benign and malignant prostate cells. A small amount of this protein leaks into the bloodstream and can be measured by a simple blood test. PSA levels tend to be higher in men with prostate cancer than those without and has led to the use of this blood test as an important tool in the detection of early stage prostate cancer. A number of factors can influence the level of PSA including age, prostate size, recent infection or procedures, and even recent sexual activity. New tests are being developed to be more specific however they are still not well standardized and are not widely accepted as being useful at this time.

Free PSA Ratio- This is a refined version of the PSA test in which the protein is further studied to determine how much of it is floating free in the bloodstream and how much is bound to other proteins. The ratio of these two different forms of PSA varies depending on the presence of cancer. This test can provide further guidance when deciding if and when to perform a prostate biopsy.

Transrectal Ultrasound- The digital exam only assesses the surface. A small ultrasound probe, not much larger than a finger can be inserted into the rectum and using sound waves, the tissue beneath the surface can be examined. Not all cancers will show up on ultrasound but in combination with the other techniques it improves detection.

Prostate Biopsy- This is the gold standard test in the diagnosis of prostate cancer. It is most often performed at the same time as the ultrasound. The procedure can be done in our office with little discomfort. While visualizing the prostate with the ultrasound, a small needle is passed into the prostate and several biopsies are usually taken. This remains the best method to determine the presence of prostate cancer.