Why the PSA test is useful in the early detection of prostate cancer!
Anyone informing themselves about the PSA test for the early detection of prostate cancer will come across 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 Guidelines for the 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 prevention.
Reduction of mortality:
The introduction of the PSA test has led to prostate tumors being detected on average about five years earlier. This is the crucial time in which curable stages of disease can turn into incurable diseases. Since the introduction of the PSA test, the proportion of curable stages has increased from about 40 to 80 percent.
Opponents of PSA often argue that most men die with their prostate cancer rather than from it. What remains unnoticed is the fact that, according to the Robert Koch Institute, in Germany there are still 11,000 to 12,000 deaths from prostate cancer every year. Even if a patient dies from a different cause, the cancer has sometimes severely impaired his or her quality of life.
Palpation alone is not enough:
In the digital-rectal examination, the urologist palpates the prostate from the rectum to detect possible hardening that could indicate a tumour. However, the palpation usually only reveals superficial tumours that have already reached a certain size. The disease is then possibly already 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 level and only 1 case is detected by digital-rectal examination.
Correct handling of the PSA test results:
The single measurement of the PSA value has only limited significance. An elevated PSA level can also be the result of benign prostate enlargement or inflammation of the prostate. Even cycling and sexual intercourse can cause the PSA level to skyrocket 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 always absolutely necessary to have a professionally well-founded assessment of the overall findings of a man and not an isolated evaluation of the PSA test result.
Not every patient needs therapy:
Early detection by means of PSA test, ultrasound and palpation will detect 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 tumours, it may be sufficient to monitor the prostate cancer closely after taking all factors into account (including type and extent of the tumour, PSA level and age) (active surveillance). Should treatment nevertheless become necessary, modern forms of brachytherapy and radiotherapy can now achieve optimal cure rates with minimal side effects.
Education is the key:
Every urologist should inform his patients in advance about the possibility of PSA determination for early detection of prostate cancer and discuss and weigh up the benefits and possible risks together. This is also what the scientific guidelines of the German Society of Urology for the early detection of prostate cancer call for.
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