I will try to sum it up as simply as possible:

A digital exam, not controversial, should be done yearly for men over 50 or younger for those at high risk

However, by the time a prostate tumor is noted on a digital (finger up the butt), it is often advanced....so nowadays the controversy surrounds the PSA (prostate specific antigen) test....it's a BLOOD test.

There are really two problems with detection with a PSA:

First, the MAJORITY of men who have an elevated PSA do NOT have prostate cancer. But like a "shadow" on a mammogram, a PSA slightly above 4.0 raises the specter of cancer and must be investigated - next step is a prostate biopsy. Not pleasant. And it turns out that about 75% of men with a PSA a bit above 4 do NOT have a cancer, but you have to get the biopsy to find out.

That's annoying but the real controversy is that even men WITH prostate cancer, a large number of them have a cancer that is indolent (very slow growing), that would not become serious or life threatening for 20-30 years. So a lot of guys in their 60's are diagnosed with prostate cancer are getting treated (most often with surgery) to treat a cancer that might not be life threatening until they are 90ish. However, once you have a diagnosis of cancer most men want to be treated/cured.

Now there are SOME prostate cancers that are serious and aggressive and really should be treated. But not all of them.

Anyway I still order PSA's on all my patients who have a life expectancy of say 10 or more years (generally up to age 80) because it's "standard of care" and it's the best test we have.

But I am hoping we eventually find a better test that will (A) find folks with cancer and leave the ones without cancer alone (better specificity) and (B) detect only cancers that are aggressive or potentially so.