Screening Methods

Different methods have been used to screen for prostate cancer.


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Digital Rectal Examination
Prostate Specific Antigen
Prostate Specific Antigen + Digital Rectal Examination
Trans-rectal Ultrasound of the Prostate
International Prostate Symptom Score

  • There is a lack of evidence that DRE is effective in prostate cancer screening.

  • DRE performed by primary care doctors has an estimated sensitivity of 51%, a specificity of 59% and a calculated overall positive predictive value (PPV) of 41%.

  • Similarly, the quality of the evidence is VERY LOW.

  • DRE may be useful for men with lower urinary tract symptoms to detect benign prostatic hyperplasia or prostate cancer.

  • If a DRE is performed and abnormalities are detected, investigation for prostate cancer should be done urgently.

  • PSA is recommended by most international guidelines as a screening method for prostate cancer.

  • However, the positive predictive values are variable:

    • PSA >4.0ng/mL: about 30%
    PSA of 4.0-10.0 ng/mL: 25%
    PSA >10 ng/mL: 42-64%

  • An elevated PSA level may not only be due to prostate cancer, but also other conditions of the prostate, including benign prostatic hyperplasia and prostatitis.

  • Combining PSA with DRE does not significantly improve the positive predictive value of prostate cancer screening compared to PSA alone.

  • In a multi-centre screening study of 6,630 men, the prostate cancer detection rate was 3.2% for DRE, 4.6% for PSA, and 5.8% for the two methods combined.

  • However, according to Prostate Cancer Foundation of Australia and Cancer Council Australia (PCFA-CCA), doing a DRE at the same time as a PSA test does not greatly increase the chance of finding prostate cancer, but can result in more men having biopsies when they do not have cancer.

  • Therefore, the combination test is not recommended.

  • Ultrasound of the prostate is used to detect disorders of the prostate gland but there is no evidence that it is useful for screening asymptomatic men for prostate cancer.

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  • IPSS is used to measure the severity of lower urinary tract symptoms; not a tool to screen for prostate cancer.

References:

  1. Catalona WJ, Richie JP, Ahmann FR, et al. Comparison of Digital Rectal Examination and Serum Prostate Specific Antigen in the Early Detection of Prostate Cancer: Results of a Multicenter Clinical Trial of 6,630 Men. J Urol. 2017;197(2S):S200-S207. doi:10.1016/j.juro.2016.10.073
  2. Naji L, Randhawa H, Sohani Z, et al. Digital Rectal Examination for Prostate Cancer Screening in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med. 2018;16(2):149-154. doi:10.1370/afm.2205
  3. Postma R, Schroder FH, van Leenders GJ, et al. Cancer detection and cancer characteristics in the European Randomized Study of Screening for Prostate Cancer (ERSPC)--Section Rotterdam. A comparison of two rounds of screening. Eur Urol. 2007;52(1):89-97. doi:10.1016/j.eururo.2007.01.030
  4. Prostate Cancer Foundation of Australia and Cancer Council Australia PSA Testing Guidelines Expert Advisory Panel. Draft clinical practice guidelines for PSA testing and early management of test-detected prostate cancer.
  5. Prostate Cancer Foundation of Australia and Cancer Council Australia, Sydney (2016). Prostate Cancer Foundation of Australia and Cancer Council Australia
  6. Hoffman, RM. Screening for Prostate Cancer. UpTodate. Available from: https://www.uptodate.com/contents/screening-for-prostate-cancer/print. Updated 1 Jul 2021. Accessed 10 Nov 2021