Traditionally, prostate cancer screening consisted of digital-rectal examination. Since 1986, however, a blood test for a tumor marker called prostate-specific antigen (PSA) has greatly increased the number of early-stage prostate cancers diagnosed. An elevated level of PSA can indicate the presence of prostatic malignancy. Elevated PSA is further investigated by an ultrasound test and needle biopsy, in which a fine needle is inserted into the gland and cells are extracted for laboratory analysis. In some cases a bone scan is also performed to rule out metastatic disease. Because PSA tests detect not only aggressive cancers but slow-growing cancers that are not life-threatening, many people disagree with routine PSA testing of asymptomatic men. A review of the test by a U.S. task force indicated that the test has led to treatments that compromise quality of life without assuring a longer life; the task force recommended (2011) that the test not be given to normal healthy men. An additional problem with the test is that some men with normal PSA levels will in fact have prostate cancer.