Category: Prostate Basics

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Sept. 6, 2016 – Digital rectal exam, the dreaded finger exam to check for prostate cancer, used to be a mainstay of check-ups for older men. With its value now in question, some doctors share the risks and benefits with their patients and let them decide. So, should they or shouldn’t they?

Ryan Terlecki, PhD
Ryan Terlecki, PhD
“The evidence suggests that in most cases, it is time to abandon the digital rectal exam (DRE),” said Ryan Terlecki, M.D., a Wake Forest Baptist urologist who recently published an article on the topic in Current Medical Research and Opinion. “Our findings will likely be welcomed by patients and doctors alike.”

Terlecki said the DRE, referred to by some urologists as a “clinical relic,” subjects a large number of men to invasive, potentially uncomfortable examinations for relatively minimal gain. In addition, it may deter some men from undergoing any test for prostate cancer. ...continue reading "Digital Rectal Exam To Detect Prostate Cancer Usually Unnecessary, Study Finds"

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Indications for Prostate Biopsy

Digital Rectal Exam (DRE)
suspicious for cancer at any PSA level		 PSA above 3 ng/mL High Risk of prostate cancer based on multiple risk factors.
TRUS (transrectal ultrasound) Guided Biopsy. In some circumstances, Doppler ultrasound- guided or MRI-guided biopsy may be preferred or required. If TRUS-guided-biopsy not done, follow up in 6 to 12 months with PSA/DRE. Consider testing FPSA, PHI, and/or PCA3 if PSA is between 3 and 10 ng/mL. Measure free PSA (FPSA), PHI (Prostate Health Index), or PCA3 in patients with PSA 3 - 10 ng/mL

...continue reading "Biopsy to Detect Prostate Cancer – when is it needed?"

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Already available, designed to reduce unneeded biopsies
May 18, 2015 ANN ARBOR, Mich. — A new urine-based test improves prostate cancer detection – including detecting more aggressive forms of prostate cancer – compared to traditional models based on prostate serum antigen, or PSA, levels, a new study finds.

The test, developed at the University of Michigan Comprehensive Cancer Center, is called Mi-Prostate Score, or MiPS. It combines PSA with two markers for prostate cancer, T2:ERG and PCA3, both of which can be detected through a urine sample. The test has been available clinically since September 2013. ...continue reading "Urine-Based Test Improves on PSA for Detecting Prostate Cancer"

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This chart shows the National Cancer Center Network Guidelines, 2014, for use of the PSA test and Digital Rectal Exam (DRE) for early detection of prostate cancer. Recommendations for men over age 70 are below the chart. prostate-cancer-early-detection-chart-png

...continue reading "Prostate Cancer Early Detection Flowchart"

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The PSA test is the first step in the early detection of prostate cancer.

As such it must be used as part of a skilled diagnostic process and selective treatment process. When to start and stop screening, at what intervals to conduct screening, and when to biopsy are among questions we look at here.

...continue reading "PSA Test – do you need it?"