With prostate cancer there are two tests that are used to screen for the cancer before any symptoms show up. The concept is to detect the cancer early - before it has a chance to spread while treatment can be used to cure the cancer instead of waiting until the cancer advances and spreads at which point there is currently no known cure. The initial test is the digital examination. In this examination the doctor employs a gloved finger to physically examine the prostate gland for any signs of enlargement, hardening, or the presence of nodules, any of which could be a sign of cancer. The second test is the PSA blood test which calculates the level of prostate specific antigen in the patient's system. A PSA above 4. ng/ml is usually considered to be abnormal. Because prostate cancer increases the PSA level when prostate cancer advances physicians normally recommend a biopsy when the PSA test registers abnormally high.

Elevated PSA test results may, though, be brought on by factors different from cancer, such as inflammation of the prostate or infection. This type of high PSA readings are classified as "false positives." A biopsy has risks, like the danger of infection and the risk of excessive bleeding. Stating the chance of false positive PSA results and the issues associated with biopsies, some doctors take a "watchful waiting" position, by which a male patient’s high PSA is monitored for several months or years. They may additionally suggest going on medication for infection to check whether such treatment reduces the PSA back to normal levels.

One of the problems with this approach is that a doctor may wait too long before suggesting a biopsy. As the PSA rises the probability increases that the rising levels are due to prostate cancer, and so does the likelihood that the cancer has spread beyond the capsule. Men with prostate cancer who have a PSA level lower than 10 ng/mL have between seventy to eighty percent chance of having organ-confined disease, as opposed to fifty percent for those with PSA levels 10 to 50 ng/mL, and only 25% with higher PSA levels

In the event the prostate cancer is not diagnosed until it has spread beyond the capsule, a man has roughly a fifty percent possibility that the cancer will progress. If the cancer spreads to the bone or to distant organs before it is found, the man typically has only a two to three year life expectancy. Treatment options may include hormone therapy, radiation therapy, orchiectomy , and possibly chemotherapy. In time, treatment might cease to be effective and the cancer will again continue to advanced. At the point where treatment ceases to be effective, prostate cancer is fatal. As of when this article was written about 90,000 men a year are going to pass away in the U.S. as a result of stage 4 prostate cancer.

This is why doctors generally recommend that a biopsy should be ordered in case a male patient’s blood test indicates a PSA level above 4. ng/ml. Since the biopsy consists of samples, a biopsy might produce a false negative, missing the cancer. This is why doctors in addition commonly recommend that biopsies be redone if the PSA levels remain elevated, even after treatment for other possible causes.

By taking a "watchful waiting" approach and just keeping track of a man's high PSA, a physician puts the man in danger of letting time go by while the cancer gets to an advanced, possibly untreatable, stage. The doctor may be liable under a malpractice claim.