No PSA test for prostate cancer?

Urologists advise against PSA testing as a screening test for prostate cancer

09/03/2013

Time and again, urologists discuss the benefits of PSA testing for the early detection of prostate cancer. Some experts and organizations, such as the German Society for Urology (DGU) even warn against using the blood test such as mammography in breast cancer screening, because the study can both save lives, but also trigger fatal false alarms. Corresponding long-term studies that allowed a harm-benefit analysis of the PSA test are currently in progress. Final results are not yet available. Professor Michael Stöckle, President of the DGU, spoke with the news agency before the annual congress of the company „dpa“ about the benefits and risks of PSA screening.

Increased value in the PSA test may indicate prostate cancer as well as benign changes
The so-called PSA test is used to detect the concentration of the prostate-specific antigen (PSA) in the blood. The higher the PSA value, the greater the probability of a change or disease of the prostate. However, benign and malignant changes of the organ have to be distinguished. For example, high levels of PSA may indicate cancer or inflammation, as well as benign enlargement of the prostate. In this inaccuracy of the PSA test many experts see the problem. If this study is introduced as a screening method, ie as a kind of screening for prostate cancer screening for men of a certain age group, not only the risk of malignant tumors in the organ and possible early stages could be detected, but also fatal false alarms are triggered in a Overdiagnosis and ultimately overtreatment could result. The results of long-term studies on the harm-benefit analysis are still pending. The DGU is also critical of the introduction of the PSA test as a screening measure.

„As with any screening program, findings and stages of disease are discovered and often treated, whose non-discovery and non-treatment would not have harmed those affected. As a result, the PSA test can also lead to overdiagnosis and overtreatment. Their actual extent, however, will only show the final evaluation of the European PSA screening study (ERSPC). In public, however, interim results are repeatedly presented as alleged final results - and cause heated controversy over the PSA test“, explains Professor Michael Stöckle of the DGU to the news agency.

PSA test can not be recommended as mass screening in the current study situation
Since the introduction of the PSA test in the US, however, the mortality rate for prostate cancer has dropped by 35 percent and „the incidence of metastatic prostate cancer by as much as 50 percent. For the USA, there are serious projections that it would triple within ten years if the test were abolished“, adds the expert. In Germany, too, the number of deaths has fallen in recent years. Nevertheless, the current study situation does not suggest that mass screenings such as breast cancer screening should be recommended with the PSA test. The DGU rather speak for a „the best possible education of people interested in early detection and also the public about advantages and disadvantages“ out. „Currently, every man should decide for himself if he does a PSA test. The personal disease risk, age and estimated life expectancy should always be considered. Especially men whose relatives are already ill at a very young age, have a four- to five-fold increased risk of disease. Family prostate cancers occur about ten years earlier than sporadic ones“, explains Stöckle and advises to regard the PSA test as a highly effective drug, „Well-dosed blessed, but used incorrectly it can be harmful“.

Although the DGU speaks out against the use of the PSA test for the screening test against prostate cancer on the basis of the current study situation, the DGU press spokeswoman Professor Sabine Kliesch in a press release on the occasion of the forthcoming congress points out that „the generalized reproach, the urologists were uncritical with the PSA test and the risk of overtreatment“ nothing to do with reality. Thus, the interdisciplinary guideline S3 contains precise instructions as to when and under which circumstances the PSA test should be used as well as four treatment options for locally limited prostate cancer and also explicitly points out the doctor's duty to inform. (Ag)

Image: Dieter Schütz