Initial screening tests for prostate cancer include a digital rectal examination, in which a doctor feels the prostate to check for abnormalities, and a blood test to detect the amount of prostate specific antigen (PSA) circulating in the blood. All men 50 years of age and older should have an annual digital rectal exam and PSA test. Men who are at higher than average risk, such as those with a family history of prostate cancer and African-American men, should begin these screening procedures at age 40. High PSA levels — greater than or equal to 4.0 ng/ml — are a possible indicator of cancer. Abnormal results on either test may be cause for concern, but they do not reveal enough information alone to definitively diagnose prostate cancer (for example, BPH can also elevate PSA levels).
If you do have abnormal findings on either screening test, your physician may suggest having a biopsy. In a biopsy several needles are inserted into the prostate to withdraw cells, and cells are then examined microscopically by a pathologist. Only with a biopsy can your doctor confirm a diagnosis of prostate cancer.
Most tumors diagnosed by screening are still confined to the prostate gland, and the chances of cure are excellent. According to the American Cancer Society, the survival rate for all stages of prostate cancer combined has increased from 67 percent to 93 percent over the past 20 years, primarily because more men are being diagnosed at an earlier stage than in years past.