A 64-Year-Old White Man Presents for Serum Prostate-Specific Antigen (PSA)

A 64-year-old white man presents for serum prostate-specific antigen (PSA) screening at his wife"s urging. He is in generally good health, except for mild hypertension. His digital rectal examination reveals a mildly enlarged prostate gland with no discrete nodules. He has no family history of prostate cancer. What is the best advice to give him?

A) There is no evidence that PSA screening leads to the earlier detection of prostate cancer
B) There is insufficient evidence to establish whether PSA screening affects overall mortality rates
C) On the basis of his lack of symptoms it is unlikely that he has an elevated PSA
D) Because a digital rectal examination is more sensitive than a serum PSA test, his normal examination makes it unlikely that he has cancer