Are PSA tests correct for prostate cancer

PSA test: early detection of prostate cancer

Status: 08/07/2020 6:09 p.m.
The PSA value is useful for the early detection of prostate cancer.

Prostate cancer is the most common type of cancer in men and the third leading cause of cancer death in western industrialized countries. In Germany alone, 66,000 men are confronted with this diagnosis every year - and more than 14,000 die from it. The timely treatment of prostate cancer that is diagnosed early offers the best chance of survival

In addition to the classic scanning of the prostate via the rectum, the determination of the so-called prostate-specific antigen (PSA) in the blood is part of the early detection test, which is recommended for men from the age of 45.

VIDEO: PSA test: early detection of prostate cancer (6 min)

Elevated PSA levels can indicate a tumor

PSA is produced in the prostate and released into the seminal fluid. It ensures that the sperm can move well. However, some of the PSA also gets into the bloodstream and can be detected there with the PSA test. Since prostate cancer cells produce more PSA than healthy cells, an elevated PSA level can be a sign of cancer.

If the PSA value exceeds an age-dependent limit for a long time, this can indicate a tumor, but it can also have other causes. A specific disease cannot be diagnosed directly from the increased value. Doctors can only conclude from this that there may be something wrong with the prostate.

Exertion can increase PSA levels

In addition to a tumor, inflammation or a benign prostate enlargement, for example, can lead to increased PSA levels. Even sexual intercourse, stubborn constipation or a bike ride in the days before the measurement are so irritating to the prostate that the PSA level rises temporarily - it can take up to 48 hours for it to fall back to the initial value.

Therefore, if the PSA value is abnormal, it should be checked after a few days. If the value is still too high, a tissue removal (biopsy) from the prostate will clarify the cause.

Contradicting Studies

The PSA test fell into disrepute due to a US study from 2012 in which 70,000 men took part. Half of the participants had their PSA values ​​determined on a regular basis, the other half allegedly did not have any tests carried out. When the PSA test showed no survival advantage, the researchers concluded that its use was pointless. At the same time, however, a European study that was twice as large over 13 years showed that regular monitoring of the PSA value leads to fewer metastases and halves the mortality rate from prostate cancer.

Faulty US study on PSA levels

A more detailed analysis of the US data by two scientists explains the contradicting results: 90 percent of the men in the control group had a PSA test carried out before or during the start of the study, thus falsifying the entire study. The consequences of the grossly flawed study were dramatic: many men did without the blood test and thus the early detection of prostate cancer. This increased the number of tumors detected too late in the USA.

Risk of the PSA test

If you have your PSA level measured regularly, you can significantly reduce the risk of dying from prostate cancer. On the other hand, there are also many rather harmless tumors that do not need to be treated. According to experts, this means that in Germany in particular, operations are carried out far too often and patients are unnecessarily exposed to the risk of complications such as incontinence or impotence. Too often, biopsies are taken because of a single increased value.

Expert opinion: Prostate screening useful?

In a recent report, the German Institute for Quality and Efficiency in Health Care (IQWiG) came to the conclusion that general prostate cancer screening, i.e. that all men over a certain age take the test, would not make sense: the harm would outweigh the benefit .

The German Society for Urology, as the responsible specialist society, views the IQWiG report critically because it does not pay sufficient attention to essential aspects. Instead of an untargeted screening, the experts recommend a so-called opportunistic, risk-adapted screening based on the PSA value. The decisive factor must be the individual risk profile, which includes not only the age of the person examined, but also his or her previous history and family history.

Interpret the PSA value correctly

At 45, at the latest at 50, the PSA value should be determined once in order to have a starting value for the further time.

  • Is the PSA level above 1.5 ng / ml, the test should be repeated in six months.
  • At a PSA level below 0.5 ng / ml the risk of prostate cancer is low. In this case, it is enough to repeat the test after five to ten years.
  • If prostate cancer has occurred in the family, PSA levels should be closely monitored.
  • A biopsy of the prostate is urgently recommended if the PSA value doubles or triples in a short period of time, if there is a palpable finding or typical symptoms such as blood in the urine.

When assessing the prostate, the overall picture is crucial. Doctors should look not just at PSA levels, but also at age, family history, baseline PSA level, and prostate size.

So that the value is not misleading, you should avoid irritation of the prostate on the days before the test, for example from cycling, sex and strong pressure when defecating. Feverish infections also falsify the PSA value.

Avoid unnecessary prostate surgery

Around 70 percent of 70-year-olds and 80 percent of 80-year-old men have prostate cancer, but only two percent of them die from it. Experts therefore no longer advise many patients under certain conditions to have an immediate operation, but rather to actively monitor the tumor. In this way you avoid unnecessary operations and the side effects caused by them, but you can intervene in good time if the cancer becomes aggressive against expectations.

Experts on the subject

Prof. Dr. Christian Wülfing, chief physician
Asklepios Clinic Altona
Paul-Ehrlich-Strasse 1
22763 Hamburg
(040) 18 18-81 16 61

Prof. Dr. Markus Graefen, Medical Director
Martini Clinic at UKE GmbH
Martinistrasse 52
20246 Hamburg

Dr. Klaus Weinzierl, urologist
Heussweg 37
20255 Hamburg-Eimsbüttel

Additional Information:
German Society for Urology V.
Uerdinger Strasse 64
40474 Düsseldorf
Statement on the final report of the IQWiG "PSA screening"

Federal Association for Prostate Cancer Self-Help e.V.
Thomas-Mann-Strasse 40, 53111 Bonn
(0228) 338 89-500
Advice hotline 0800-70 80 123

Cancer Information Service (KID)
German Cancer-research center
(0800) 420 30 40 (8 a.m. to 8 p.m., free of charge from German landlines)

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Visit | 08/11/2020 | 8:15 pm