Senior Director & Unit Head, Urology, Kidney Transplant, Uro-Oncology, Robotic Surgery, Max Hospital, Gurugram
Part 4 of 11 in Prostate Cancer: Diagnosis and Management
How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
September 6, 2026
Dr. Amit Goel's practice begins prostate cancer detection the same way for every patient: a PSA test for any man aged 55 or older who walks into the urology clinic, regardless of what brought them in. If the PSA level comes back elevated, that raises suspicion of prostate cancer and leads to further examination and testing.
The Digital Rectal Examination
Every male patient examined for a urinary problem in Dr. Goel's clinic also gets a digital rectal examination, since it is quick and can pick up a hard nodule that the PSA test alone would miss. A hard nodule found on rectal exam turns out to be cancer roughly 50 to 55 percent of the time, which is why any patient with a palpable nodule on digital rectal examination goes straight to biopsy.
When PSA Alone Isn't Enough
PSA alone does not diagnose cancer. An elevated reading raises suspicion and prompts further examination and biopsy, not a confirmed diagnosis by itself. Combined with a digital rectal exam, PSA remains the practical, low-cost first screening step, and it is why Dr. Goel tests every patient over 55 rather than waiting for symptoms to appear.
This article is based on a Jivo Masterclass session conducted by Dr. Amit Goel, Director and Head of Unit, Renal Transplant, Uro-oncology, Urology and Robotic Surgery, Max Hospital, Gurugram, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Amit Goel taught doctors across Africa on April 20, 2025.
FROM THE LIVE Q&A
Dr. Navala Gabriel
What is the average cost of robotic surgery for prostate cancer?
Dr. Amit Goel
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
Frequently Asked Questions
What is the management of metastatic prostate cancer?▼
It depends on where the metastasis is. Bilateral orchidectomy is still a valid option for patients who don't want to spend money on ongoing hormone injections, and it works about as well as hormone therapy. For bone metastasis with pain or fracture risk, bone-strengthening injections and radiotherapy to the affected bone are added. Once the disease becomes castration-resistant, treatment moves to stronger anti-androgens such as abiraterone or enzalutamide, chemotherapy for visceral metastasis, and increasingly immunotherapy.
What are the survival chances after surgical treatment for a patient with prostate adenocarcinoma, and is there a possibility of recurrence?▼
Surgery is offered specifically in patients where the goal is cure. But every patient needs lifelong follow-up, with PSA testing every three to six months, because recurrence can and does happen. Nobody can promise a patient that surgery guarantees no recurrence. That possibility is exactly what the word cancer is telling us.
What is the average cost of robotic surgery for prostate cancer?▼
Approximately 8,700 US dollars, which is the total cost of the robotic surgery.
At what age should men start PSA testing?▼
Dr. Amit Goel tests every patient aged 55 or older who visits the urology clinic, regardless of the reason for the visit.
How reliable is a digital rectal exam for prostate cancer?▼
A hard nodule found on digital rectal examination turns out to be cancer in roughly half of cases, which is why a palpable nodule is followed directly by a biopsy.
In This Series: Prostate Cancer: Diagnosis and Management
- 1.Diagnosis and Management of Prostate Cancer
- 2.Prostate Cancer Risk Factors and Why Men of African Descent Face the Highest Risk
- 3.Recognizing Prostate Cancer: From Early Symptoms to Advanced and Metastatic Disease
- 4.How Prostate Cancer Is Diagnosed: PSA Testing and Digital Rectal Examination
- 5.Prostate Biopsy: TRUS-Guided and MRI Fusion Techniques
- 6.The Gleason Score: Grading Prostate Cancer and What It Means for Treatment
- 7.Staging Prostate Cancer: TNM Classification and PSMA PET Scans
- 8.Choosing a Treatment: Risk-Based Options From Active Surveillance to Surgery
- 9.Robotic, Laparoscopic and Open Radical Prostatectomy: Comparing the Evidence
- 10.The Retzius-Sparing Technique: Protecting Continence and Erectile Function After Surgery
- 11.Managing Metastatic and Castration-Resistant Prostate Cancer