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III. Evaluating Prostate
Health 
Digital Rectal Examination (DRE).
The standard technique for evaluating the health of the prostate is by physical examination called a digital rectal exam (DRE). Typically, a patient is asked to bend forward over a table while the doctor inserts a gloved and lubricated finger (called a digit in the medical community) into the patient's rectum. This allows the physician to feel the back portion of the prostate gland. In addition to gauging the gland's size, the doctor is able to evaluate its firmness and texture. The doctor looks for answers to some key questions: Has its usual rubbery feel changed? Are there any hard areas or lumps, which could signal a cancer? Has a growth spread beyond the prostate?
Prostate-Specific Antigen (PSA).
This is a substance produced by cells of the prostate gland. PSA circulates in the blood and can be detected and measured with a relatively simple blood test. When the gland enlarges, PSA levels rise. PSA levels can also rise if cancer develops.
Generally, doctors consider readings below 4 nanograms per milliliter (ng/ml) to be normal, scores between 4 and 10 to be slightly elevated, scores between 10 and 20 to be moderately elevated, and anything above that to be highly elevated. Most men with BPH have levels of 10 ng/ml or below.
"Compared with most cancers, prostate cancer tends to grow slowly. It may be decades from the time the earliest cell changes can be detected under a microscope until the cancer gets big enough to cause symptoms."
However, many factors can influence PSA levels. Some prostate glands naturally produce more PSA than others. PSA scores also tend to increase with age. Another influence on PSA levels is race: PSA levels tend to be higher in African-Americans, and lower among Japanese, than in white Americans.
A variety of conditions can raise PSA levels temporarily. These include prostatitis, prostate biopsy, and transurethral prostate surgery.
Transrectal Ultrasound (TRUS).
This procedure uses a small probe that is inserted into the rectum. The probe emits and picks up high-frequency sound waves. The sound waves bounce off the prostate, producing a pattern that is converted into a video image. Areas of cancer produce a different pattern than healthy tissue. The value of a TRUS is strongly influenced by the quality of the equipment and the skill of the person operating it.
While ultrasound does not provide enough specific information to make it a good screening tool by itself, doctors find it useful as a followup to a suspicious DRE or PSA. TRUS is also used to guide biopsies in sampling abnormal areas of the prostate, to estimate the volume of the prostate for calculating PSA density, and to situate radiotherapy implants.
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