A 50 year old male with positive family history of prostate cancer has come to you for a screening test. The MOST sensitive screening test to pickup prostate cancer is:

The risk of being diagnosed with prostate cancer increases by a factor of two if one first-degree relative is affected and by four if two or more are affected. The American Cancer Society (ACS) recommends that physicians offer PSA testing and a digital rectal examination (DRE) on an annual basis for men older than age 50 years for screening. In general, a biopsy is recommended if the DRE or PSA is abnormal. Ref: Scher H.I. (2012). Chapter 95. Benign and Malignant Diseases of the Prostate. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L. Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.