Prostate-specific antigen blood test 
This blood test to measure PSA - a protein which is made by prostate cells - is recommended annually to men over 50 and to younger men

with high prostate cancer risk. 

PSA blood test results are reported as nanograms per milliliter (ng/ml). Results under 4 ng/ml are usually considered normal. Results over 10 ng/ml are high and values between 4 and 10 are considered borderline. The higher the PSA level, the more likely the presence of prostate cancer. 

PSA levels estimate how likely a man is to have prostate cancer but conditions such as benign prostate hyperplasia (non-cancerous prostate enlargement) can cause a borderline or high PSA result. ON the other hand, some men with prostate cancer have negative or borderline PSA results. Several medications and herbal preparations can also lower blood PSA levels. Men with a high PSA result are advised to have a biopsy, to find out whether or not cancer is present. 

After surgery or radiation treatment, rising PSA levels can provide an early sign that the cancer is coming back.

Digital rectal examination
The doctor inserts a gloved, lubricated finger into the patient's rectum to feel for any irregular or abnormally firm area that might be a cancer. This is called a digital rectum examination (DRE).

The prostate gland is located next to the rectum, and most cancers begin in the part of the gland that can be reached by a rectal exam. The exam causes no pain and only takes a short time.

If the DRE result is abnormal, a biopsy is recommended regardless of the PSA levels. DRE is less effective than the PSA blood test in finding prostate cancer but can sometimes and cancers in men with normal PSA levels. The DRE is also used once a man is known to have prostate cancer, in order to help predict whether the cancer has spread beyond his prostate gland. It is also used to detect cancer that has come back after treatment.


Transrectal ultrasound
Transcrectal ultrasound (TRUS) uses sound waves to create an image of the prostate on a computer screen.

Sound waves are released from a small probe placed in the patient's rectum. The sound waves create echoes as they enter the prostate. The same rectal probe detects the echoes that bounce back from the prostate and a computer translates the pattern of echoes into a picture.

Because prostate tumors and normal prostate tissue often reflect sound waves differently, this test may be useful in detecting tumors, even those which might be too small or located in areas of the gland that cannot be felt by DE. The procedure is essentially painless and takes about 10-20 minutes.

TRUS is useful when the PSA or DRE indicates an abnormality, to guide the biopsy needle into exactly the right area of the prostate.

The prostate biopsy
A biopsy is a surgical procedure that removes a sample of tissue for examination. A core needle biopsy is the main method used to diagnose prostate cancer. Under transcrectal ultrasound guidance a doctor inserts a narrow needle through the wall of the rectum into the area of the prostate gland that appears abnormal. The needle then removes a cylinder of tissue, which is then tested. The procedure takes about half an hour and causes little discomfort.

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