A 72 years old Dayaram underwent routine medical examination. Digital rectal examination shows a nodule on prostate. Serum examination shows elevated PSA levels. What is the next step of investigation?

The appropriate screening examinations for prostate cancer include a serum PSA and DRE. On the basis of an elevated PSA or an abnormal DRE, the patient should be referred for a transrectal ultrasound-guided prostate biopsy. In general, six to twelve cores are taken for evaluation; areas that are abnormal on DRE may receive more biopsy attempts. Also know: Prostate specific antigen (PSA) is a protein produced and secreted by both normal prostate and prostate cancer cells. It provides a sensitive but not highly specific screening test, as it is also elevated with BPH, inflammation, and infection of the prostate. The proposed cutoff is 4.0 ng/mL, but studies have shown that 15% of men with normal PSA levels will have prostate cancer and 2% will have high-grade prostate cancer. Ref: Pienta K.J. (2009). Chapter 96. Prostate Cancer. In J.B. Halter, J.G. Ouslander, M.E. Tinetti, S. Studenski, K.P. High, S. Asthana (Eds), Hazzard's Geriatric Medicine and Gerontology, 6e.