Reportedly, most cases of prostate cancer are identified by screening of asymptomatic males and most cases show no symptoms—but there is controversy regarding screening. The American Cancer Society and American Urological Association have issued guidelines that differ on specific points but agree on the value of prostate screening on selected populations, for patients who agree to screening after a discussion of the risks and benefits. Males with a positive family history who are most likely to benefit from screening are those with a first degree relative who had advanced PC at diagnosis, who developed metastatic PC, or who died of PC. Physical examination alone cannot differentiate between benign prostatic disease (BPD) and cancer. There are two necessary components for a modern prostate screening protocol. One component is a DRE (digital rectal examination):
· It tends to be examiner dependent (e.g., how skilled or experienced the person is)
· Serial examinations over time are best for comparison.