PSA test from 40!

Cologne, November 3rd, 2009 - Men should go to the urologist for the first time at the age of 40 to prevent prostate cancer, is the recommendation of the new guideline on the early detection, diagnosis and treatment of prostate cancer, which was 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 as to its effectiveness. Whereas the simple blood test for the determination of prostate specific antigen (PSA) was previously recommended for men from the age of 50 and for men with a family history from the age of 45, men over the age of 40 should now be tested. 

PSA progression important for therapy decision

If the PSA test is carried out once, the value indicating the concentration of the prostate-specific protein in the blood usually has only a minor significance. Dr. Stephan Neubauer, urologist at the West German Prostate Center, explains:"Only the course of the values over time shows whether a prostate carcinoma may be present. With the now earlier PSA determination, a affected person can gain many years in which the course of the PSA values is observed. A reduction in age for the first early diagnosis measure may help to distinguish between existing and missing need for therapy by the PSA course, according to the exact wording of the new guideline. Dr. Neubauer explains,"If the PSA level really soars, the comparative values from previous years can serve as an important diagnostic tool. 

Thus, not every patient whose blood exceeds the previous limit of 4 ng/ml is also suffering from cancer. 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 therefore all the more important not to panic when PSA levels are raised once, but to repeat the test several times and to use additional diagnostic procedures such as ultrasound elastography and prostate palpation. However, the reality is often different: It still happens that a biopsy is performed prematurely due to a single increase in the PSA value. It's not the test that makes the mistake, it's the doctor,"Dr. Neubauer complains. 

Prostate removed too early

If carcinogenic tissue is discovered by biopsy of the prostate gland, it is often operated prematurely, although this is not always the best treatment strategy. Prostate carcinomas, which are classified as not life-threatening, can be monitored with a clear conscience on the basis of PSA test, sonography, palpation and renewed biopsies,"explains Dr. Neubauer. In addition, the focus in the treatment of prostate cancer patients must be increasingly on achieving optimal healing rates with minimal side effects. Modern radiation therapy methods such as brachytherapy (internal radiation) are particularly suitable for this purpose. In contrast to radical removal of the prostate, the prostate gland remains intact. The ultrasound-guided introduction of radioactive pencils (seeds) directly into the prostate gland destroys the tumour and at the same time protects the surrounding tissue. According to Dr. Gregor Spira, radiotherapist at the West German Prostate Center,"Incontinence is virtually non-existent after brachytherapy and impotence is observed much less frequently. The advantage of "internal radiation" lies in the fact that patients have to accept significantly lower side effects for the treatment without any loss of healing.

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