**Core Concept**
Prostate cancer screening in men with a positive family history relies on combining clinical assessment with biomarker testing. Digital Rectal Examination (DRE) evaluates prostate texture and size, while Prostate-Specific Antigen (PSA) measures serum levels of a protein produced by prostate tissue—elevated levels may indicate malignancy.

**Why the Correct Answer is Right**
DRE + PSA is the standard of care for prostate cancer screening in high-risk individuals, including those with a family history. DRE detects physical abnormalities such as nodules or asymmetry, while PSA provides a quantitative biomarker. Together, they improve sensitivity and specificity over either test alone. The combination is recommended by major guidelines (e.g., NCCN, USPSTF) for men at increased risk, enabling earlier detection and timely intervention.

**Why Each Wrong Option is Incorrect**
Option A: DRE alone is insufficient as it lacks sensitivity and specificity; it may miss early-stage cancer and can produce false positives.
Option B: PSA alone has a high false-positive rate and cannot distinguish between benign and malignant conditions without further evaluation.
Option D: Endorectal coil MRI with T1/T2 images is highly accurate but is not routinely used for screening due to cost, availability, and limited proven benefit in asymptomatic men.

**Clinical Pearl / High-Yield Fact**
The "DRE + PSA" combination remains the most practical and guideline-recommended initial screening strategy for men with familial risk, with annual monitoring advised until age 70 or as per individual risk assessment.

✓ Correct Answer: C. DRE + PSA