PSA test: Urologists criticise IQWiG report

In its final report of April 2020, the German Institute for Economic Efficiency in Health Care (IQWIG) also advised against the general determination of the PSA value for the early detection of prostate cancer, despite major objections from national and international professional associations. The Institute also receives strong criticism from the German Society of Urology (DGU). "Rightly so", say Dr. Stephan Neubauer and Dr. Pedram Derakhshani of the West German Prostate Center in Cologne.

Numerous criticisms of the IQWIG report

Screening for prostate cancer using the PSA test harms significantly more men than it helps, as more patients are overdiagnosed - this is IQWiG's conclusion. However, the Institute's scientific approach is criticised in many ways:  For example, only a small proportion of patients (0.7 to 1.6 percent) are likely to be overdiagnosed, as long as the standard German PSA limit of 4 ng/ml is applied.

The evaluation is also based on the fact that in prostate cancer screening using the PSA test, all men of a certain age are asked to undergo a PSA test regardless of concomitant diseases and risk profile. According to the DGU, however, the reality is different: "In contrast to the systematic, purely age-related screening using PSA considered by IQWiG, risk-adapted PSA diagnosis has been performed for years in accordance with urological guidelines as a component of prostate cancer screening. 

Furthermore, the Society criticizes the selection of the studies consulted for the evaluation. While IQWIG "firmly conceded the plausibility of the concept of PSA-based early diagnosis", it ultimately pointed to the results of the ProScreen study from Finland and the Gothenburg study, which are expected in 2028, instead of considering current results of the PROBASE study, which will be published at the end of the year," emphasizes the DGU.

PSA remains the most important instrument for early detection

Only by means of PSA testing can early detection and therapy of the most common male tumour be guaranteed and the increased occurrence of metastasised disease stages prevented, according to the conclusion of Germany's leading urologists. Correct handling of the test results plays an important role, the Cologne urologists explain. 

For example, a uniquely 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 soar in the short term. It is therefore important to repeat the test and use additional other diagnostic procedures, is the recommendation of the West German Prostate Center. An effective early detection includes PSA testing, ultrasound and palpation of the prostate. Therefore, it is always essential to have a well-founded professional evaluation of the overall findings of a man and not to look at the PSA level in isolation. 

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