What combination of tests is typically used for initial evaluation of suspected prostate cancer?

• A. DRE alone
• B. PSA testing alone
• C. PSA testing plus digital rectal examination (DRE), with biopsy if indicated after risk assessment
• D. MRI pelvis

Answer: (C)

The key idea is that initial evaluation relies on both a blood test for a biochemical marker and a physical examination to stratify risk before moving to tissue diagnosis. Measuring PSA in the blood helps flag potential prostate issues, but PSA can be elevated for reasons other than cancer, such as benign enlargement or inflammation. A digital rectal examination complements this by allowing the clinician to feel the prostate for any nodules, asymmetry, or irregularities that raise concern. Using both tests together gives a fuller picture of cancer risk than either test alone.

If the combination of findings suggests a higher risk after this initial assessment, a biopsy is performed to obtain tissue and confirm cancer histology. This step is the definitive diagnosis, guiding subsequent management.

Imaging like MRI pelvis is valuable in planning biopsies or evaluating known cancer, but it isn’t the baseline screen for everyone with suspected cancer.