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Anyone seeking information about the PSA test for the early detection of prostate cancer encounters contradictory information and recommendations. However, the German Society of Urology and the German Cancer Society leave no doubt about its effectiveness in the Interdisciplinary S3 Guideline for Early Detection, Diagnosis and Therapy of Prostate Cancer. The West German Prostate Center at the KLINIK am RING in Cologne explains why the PSA test should be an important part of individual screening.
The introduction of the PSA test has resulted in prostate tumors being detected on average about five years earlier. This is the crucial time when curable disease stages can become incurable diseases. Thus, the proportion of curable stages has increased from about 40 to 80 percent since the introduction of the PSA test.
PSA opponents often argue that most men die with their prostate cancer, not from it. This ignores the fact that, according to the Robert Koch Institute, there are still 11,000 to 12,000 deaths from prostate cancer in Germany every year. Even if a patient dies beforehand from another cause, he or she has sometimes suffered severe losses in quality of life as a result of the cancer.
During the digital-rectal examination, the urologist palpates the prostate from the rectum to detect possible indurations that could indicate a tumor. However, palpation usually only detects superficial tumors that have already reached a certain size. The disease may then already be in an advanced stage and can only be cured to a limited extent. Studies show that out of 12 patients with prostate cancer, 11 cases are detected by measuring the PSA value and only 1 case by digital-rectal examination.
The one-time measurement of the PSA value has only limited significance. An elevated PSA value can also be the result of a benign prostate enlargement or an inflammation of the prostate. Even cycling and sexual intercourse can cause the PSA level to rise in the short term. It is therefore important to repeat the test promptly and, if necessary, to use other diagnostic procedures in addition to ultrasound and palpation for further clarification. It is essential to always make a professional, well-founded assessment of a man's overall findings and not to evaluate the PSA test result in isolation.
Early detection using PSA testing, ultrasound and palpation detects more early stages of prostate cancer. Some of these are tumors that have a low risk of growing. In the case of so-called low-risk tumors, it may be sufficient to monitor the prostate cancer closely (active surveillance) after taking all factors into account (including the type and extent of the tumor, PSA level and age). Should treatment nevertheless become necessary, modern forms of brachytherapy and radiotherapy can now achieve optimal cure rates with minimal side effects.
Every urologist should inform his patients in advance in detail about the possibility of the PSA value determination for the early detection of prostate cancer and discuss and weigh the benefits and possible risks together. This is also required by the scientific guideline of the German Society of Urology for the early detection of prostate cancer.
