Prostate cancer has become the 7th most common malignancy in Taiwan in 2000. To our knowledge, many diagnostic tests have been developed, including digital rectal examination (DRE), transrectal ultrasound (TRUS), prostate specific antigen (PSA), PSA density (PSAD), PSA velocity, age-specific PSA, and free-to-total PSA, but none of them has been proven to be definitely effective in deciding which person is to receive prostate biopsy. Viewpoints vary with clinician and area. A total of 300 patients over 7-year time period received DRE, TRUS, PSA, and PSAD tests and then had prostate biopsy in Kaohsiung Medical University Hospital. We collect our results and review the literature to find the cost-effectiveness of the tests to prevent unnecessary biopsy and delay in diagnosis. Fifty-two patients (19%) with PSA > 4 ng/ml had prostate cancer. Only 10.5% of patients with prostate cancer had abnormal TRUS lesions, and 20% with prostate cancer showed abnormal DRE results. Because of DRE is non-invasive and inexpensive, we commend the annual use of DRE combined with PSA check in males of 50 years and above to screen for prostate cancer, despite the poor sensitivity of DRE. Therefore, in cases where there is either PSA > 4 ng/ml or abnormal DRE results, it is suggested that patients receive prostate biopsy. There is still no definite conclusion in other diagnostic tests including TRUS.