No PSA test for prostate cancer?

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Urologists do not recommend PSA testing as a screening test for prostate cancer

Urologists are constantly discussing the benefits of PSA tests for the early detection of prostate cancer. Some experts and organizations such as the German Society for Urology (DGU) even warn against using the blood test like mammography for breast cancer screening, because the examination can save lives on the one hand, but also trigger fatal false alarms on the other. Corresponding long-term studies that allow a benefit-benefit analysis of the PSA test are currently underway. However, final results are not yet available. Professor Michael Stöckle, President of the DGU, spoke to the news agency "dpa" about the advantages and risks of PSA screening before the company's annual congress.

Increased levels in the PSA test can indicate prostate cancer but also benign changes. The so-called PSA test detects the concentration of the prostate-specific antigen (PSA) in the blood. The higher the PSA value, the greater the likelihood of a change or disease of the prostate. However, benign and malignant changes in the organ must be distinguished. A high PSA value can indicate cancer or inflammation, among other things, but just as well a benign enlargement of the prostate. Many experts see the problem in this inaccuracy of the PSA test. If this examination is introduced as a screening method, i.e. as a type of screening for prostate cancer screening for men of a certain age group, not only the risk of malignant tumors in the organ and possible early stages could be recognized, but also fatal false alarms that are triggered in a Overdiagnosis and ultimately overtreatment could result. The results of long-term studies on harm-benefit analysis are still pending. The DGU is also critical of the introduction of the PSA test as a screening measure.

“As with any early detection program, findings and stages of the disease are discovered and often treated, the non-detection and non-treatment of which would not have harmed those affected. As a result, over-diagnosis and over-therapy can also occur in the PSA test. However, the actual extent will only be shown by the final evaluation of the European PSA screening study (ERSPC). However, interim results are always presented to the public as supposed final results - and cause heated controversy about the PSA test, ”explains Professor Michael Stöckle from the DGU to the news agency.

PSA test cannot be recommended as mass screening in the current study situation. However, since the introduction of the PSA test in the USA, the death rate for prostate cancer there has decreased by 35 percent and “the frequency of metastatic prostate cancer has even dropped by 50 percent. There are serious projections for the United States, according to which it would triple within ten years if the test were to be abolished, ”adds the expert. In Germany, too, the number of deaths has decreased in recent years. Nevertheless, the current study situation does not yet exist to recommend mass screening like the breast cancer screening with the PSA test. The DGU rather advocates "the best possible education for men who are interested in early detection and also for the public about advantages and disadvantages". “At the moment, every man should decide whether to take a PSA test. The personal risk of illness, age and estimated life expectancy should always be taken into account. Men in particular, whose relatives are ill at a very young age, have a four to five times higher risk of developing the disease. Family prostate cancers occur about ten years earlier than sporadic ones, ”explains Stöckle and advises that the PSA test be considered a highly effective medication.“ Well-dosed is beneficial, but it can be harmful if used incorrectly ”.

Although the DGU is against the use of the PSA test for screening for prostate cancer based on the current study situation, the DGU press spokeswoman Professor Sabine Kliesch points out in a press release on the upcoming congress that "the generalized accusation that the urologists went uncritically with the PSA test and the risk of over-therapy to “have nothing to do with reality. The interdisciplinary guideline S3 contains precise instructions on when and under what circumstances the PSA test should be used as well as four treatment options for locally limited prostate cancer and also expressly refers to the doctor's duty to inform. (ag)

Image: Dieter Schütz /

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Video: One-off PSA screening for prostate cancer does not save lives


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