Most men should begin regular prostate screenings at age 50, but for men at higher risk for prostate conditions based on race, medical or family history, screenings can start as early as 40 to 45. Regular prostate screenings can detect prostate cancer at an early stage, even when signs and symptoms are completely absent.
Digital Rectal Exam (DRE)
One of the most common ways your doctor will diagnose a prostate condition is with a digital rectal exam (DRE). Your doctor will insert a gloved finger into the rectum to examine the prostate for lumps, soft spots, hard spots or other abnormalities that could be a sign of a prostate condition.
Your doctor may also perform a prostate massage to drain fluid into the urethra for analysis. A DRE can detect BPH, prostate cancer and prostatitis, while prostate massage is only normally performed when your doctor suspects inflammation or infection usually associated with prostatitis.
PSA Blood Test
A prostate-specific antigen (PSA) blood test detects a specific protein in the blood produced by the prostate to fight infection and inflammation. The higher the levels of PSA in the blood, or the greater the change in your PSA yearly, the more likely it is that you have prostate cancer, though high PSA levels can be the result of a non-cancerous infection. A PSA blood test is usually paired with a digital rectal exam, primarily used to detect prostate cancer in men with or without signs or symptoms.
A PSA blood test may also be used once prostate cancer has been diagnosed. In conjunction with a digital rectal exam and a tumor grade (determined from a biopsy), a PSA blood test can help determine how far your cancer may have spread (called "staging") and help your doctor select appropriate treatment options.
PSA blood tests are also used regularly following prostate cancer treatment to monitor PSA levels every few months to safeguard against a return of the cancer. The PSA will decrease and gradually approach zero after treatment for prostate cancer.
A number of imaging techniques can be used to diagnose prostate conditions from X-rays to digital scans. Your doctor may want to get a picture of your prostate using either X-rays or a sonogram. An intravenous pyelogram (IVP) is one method of imaging where dye is injected into the vein and an X-ray performed on the urinary tract to detect abnormalities or obstructions. This is rarely used anymore. A rectal sonogram can also be used where a probe is inserted into the rectum where it can bounce sound waves off the prostate to scan for problems, as well as measuring the true size of the gland. CT scans, MRIs and ultrasounds can also be used to get a better picture of your prostate health without surgery.
Urine Flow Study or Urine/Semen Culture
Your doctor may be able to diagnose prostate conditions with a urine flow study or by collecting a urine or semen culture for analysis. A urine flow study measures how quickly your urine is flowing. A reduced flow with a full bladder, including weak stream or dribbling, may mean you have BPH.
A urine or semen culture involves specimen collection for later lab analysis. A urine culture is often used in collaboration with prostate massage to collect urine and prostatic fluid to analyze for the presence of white blood cells and bacteria that may mean you have prostatitis.
A cystoscopy is similar to a colonoscopy but for the urinary tract rather than the digestive tract. A cystoscopy is an examination in which a flexible tube is inserted into the bladder through the urethra, giving your your doctor an inside view of your bladder and urinary tract.