PSA test: Urologists criticise IQWiG preliminary report
In a recently published preliminary report, the Institute for Quality and Efficiency in Health Care (IQWiG) advised against the general determination of the PSA value for the early detection of prostate cancer. The reason: PSA screening spares some patients the burden of metastatic cancer, but damage due to overdiagnosis and overtherapy outweighs this. However, the urologists organised in the German Society of Urology (DGU) strongly criticise the preliminary report. "Rightly so", say also Dr. Stephan Neubauer and Dr. Pedram Derakhshani of the West German Prostate Center in Cologne.
IQWiG's conclusion not plausible
If the PSA limit value of 4 ng/ml, which is customary in Germany, is taken as a basis, only a small proportion of patients, namely 0.7 to 1.6 percent, can be expected to be overdiagnosed. However, important current studies that would invalidate IQWiG's argumentation were not or only partially taken into account, according to the expert association's statement.
The DGU also criticises the use of the term "false positive" in the IQWiG report, as it is misleading, especially for patients. A PSA value greater than 4 ng/ml is not proof of prostate cancer. Rather, the one-time measurement of the PSA value has only limited informative value, Dr. Neubauer also says: "Time and again, it happens that PSA values are misinterpreted and rash action is taken".
Correct handling of PSA test results
A one-time elevated PSA level can thus 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 and to use additional other diagnostic procedures, recommends the Cologne prostate specialist. Effective early detection includes PSA testing, ultrasound and palpation of the prostate. Therefore, it is always essential to have a well-founded evaluation of the overall findings of a man and not an isolated evaluation of only the PSA level.