A proper medical interview and physical examination are essential in the diagnostic workup of any man in whom prostate cancer is suspected. You may be referred to a physician who specializes in urinary tract diseases (a urologist) or in urinary tract cancers (a urologic oncologist). You will be asked questions about your medical and surgical history, your lifestyle and habits, and any medications you take.

Because the symptoms may indicate a variety of conditions, you will undergo testing to pinpoint their cause. Initial screening tests include the digital rectal examination as well as blood testing for PSA and urine testing for blood or signs of infection.

Blood tests: These are used to detect complications of prostate cancer.

• Complete blood cell count: Your hemoglobin level and relative amounts of different blood cells are checked. Anemia is a common sequel to cancers, as are certain other blood irregularities.

• Hepatic transaminases: These are enzymes produced in the liver. They are called alanine aminotransferase (ALT) and aspartate aminotransferase (AST). In known prostate cancer, these levels are usually elevated when the cancer has spread to the liver. However, levels of these enzymes can be abnormally high in a number of different conditions that have nothing to do with cancer.

• Alkaline phosphatase: This enzyme is found in the liver and in bone. It is a sensitive indicator of both liver and bone cancer.

• BUN and creatinine: These measures are used to assess how well the kidneys are working. Levels can be elevated in a number of conditions and may suggest an obstruction.

Prostatic specific antigen (PSA): This is an enzyme produced by both normal and abnormal prostate tissues.

• It may be elevated in noncancerous conditions, such as prostatitis (inflammation of the prostate) and benign prostatic hypertrophy (noncancerous enlargement of the prostate), as well as in cancer of the prostate.

• PSA values may be more helpful over time in following recurrence of cancer and the response to treatment than in diagnosing a previously unknown cancer.