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Prostate Cancer: The Role of PSA Testing and Digital Rectal Exam in Early Diagnosis

A middle-aged Hispanic physician in a white coat and stethoscope explains to a Hispanic patient in his 50s the use of a prostate gland model to illustrate the importance of prostate-specific antigen (PSA) levels and digital rectal exams in the early diagnosis of prostate cancer. On the desk, there are charts showing PSA levels, emphasizing the focus on early detection.

Prostate cancer is one of the most common neoplasms in men, and early diagnosis is crucial for improving clinical outcomes. Two fundamental tools in the early detection of prostate cancer are prostate-specific antigen (PSA) testing and the digital rectal exam. These tests allow for the identification of changes in the prostate that may indicate the presence of cancer, even before symptoms such as nocturia appear.

Diving Deeper into PSA Testing and the Digital Rectal Exam

The PSA is a widely used biomarker in the early diagnosis of prostate cancer. However, its specificity is limited, which can lead to unnecessary biopsies. Studies have shown that using the percentage of free PSA can improve the specificity of total PSA, especially at levels of 4-10 ng/ml, where most false positives occur [1]. Furthermore, the combination of PSA testing with the digital rectal exam has demonstrated superior sensitivity and positive predictive value compared to other cancer screening tests [1].

The digital rectal exam, although often underestimated, remains an essential part of the detection process. It allows the physician to physically assess the prostate for abnormalities that may not be detected by PSA testing alone. The combination of both tests is recommended by multiple clinical guidelines to maximize the detection of clinically significant cancers [2].

Additionally, emerging technologies such as multiparametric magnetic resonance imaging (mpMRI) and micro-ultrasound (MicroUS) are being integrated into the diagnostic process, offering greater accuracy in identifying high-grade cancers [3]. However, access and cost remain significant barriers to their widespread use.

Conclusions

Early detection of prostate cancer through PSA evaluation and the digital rectal exam remains a fundamental strategy in clinical practice. Although PSA has limitations, its combined use with the digital rectal exam and new imaging technologies can significantly enhance diagnostic accuracy. It is essential for physicians to continue educating themselves on the latest research and technologies to optimize patient management and reduce the number of unnecessary biopsies [4].

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Created 13/1/2025