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Cologne, November 3, 2009 - Men should start seeing a urologist for prostate cancer screening as early as age 40, according to the new guideline on early detection, diagnosis and treatment of prostate cancer recently presented by the German Society of Urology (DGU).
Despite controversial discussions about the PSA test as a proven method for the early detection of prostate cancer, the current guideline on prostate cancer leaves no doubt about its effectiveness. While the simple blood test to determine the prostate-specific antigen (PSA) was previously recommended for men from the age of 50, and in the case of a family history from the age of 45, men from the age of 40 should now be tested.
If the PSA test is performed once, the value indicating the concentration of the prostate-specific protein in the blood usually has only a subordinate significance. "Only the progression of the values over time shows whether a prostate carcinoma is possibly present," explains Dr. Stephan Neubauer, urologist at the West German Prostate Center. With the now earlier PSA determination, an affected person can gain many years in which the course of the PSA values is observed. Lowering the age for the first screening measure can possibly help to better distinguish between existing and missing need for therapy by the PSA progression, according to the exact wording of the new guideline. "If the PSA value should then actually skyrocket, the comparative values of the previous years can serve as an important diagnostic tool," explains Dr. Neubauer.
Thus, not every patient whose blood exceeds the previous limit of 4 ng/ml also has cancer. This is because physical exertion such as cycling, inflammation of the prostate or bladder, and sexual intercourse can cause the PSA in the blood to rise for a short time. The urologist advises that it is all the more important not to panic in the event of a one-time increase in PSA values, but to repeat the test several times and to use additional diagnostic procedures such as ultrasound elastography and palpation of the prostate. However, the reality is often different: It still happens that a biopsy is hastily ordered based on a one-time elevated PSA value. "It's not the test that makes the mistake here, but the doctor," complains Dr. Neubauer.
If carcinogenic tissue is discovered on the basis of prostate tissue sampling (biopsy), surgery is often performed prematurely, although this is not always the best treatment strategy. "Prostate cancers that are not considered life-threatening can be actively monitored initially with a clear conscience using PSA testing, sonography, palpation and repeat biopsies," explains Dr. Neubauer. In addition, the focus in the treatment of prostate cancer patients must increasingly be on achieving optimal cure rates with minimal side effects. Modern radiotherapeutic methods, such as brachytherapy (internal radiation), are particularly suitable for this purpose. Unlike radical removal of the prostate, the prostate gland remains intact. Ultrasound-guided insertion of radioactive pins (seeds) directly into the prostate gland, specifically destroys the tumor while sparing the surrounding tissue. "Incontinence is practically not observed after brachytherapy, and impotence is observed much less frequently," says Dr. Gregor Spira, a radiation therapist at the West German Prostate Center. The advantage of "internal radiation" is that patients have to accept significantly fewer side effects for the treatment without having to fear losses in healing.
