PSA-based prostate cancer screening soon recommended therapy?

Experts change their mind about PSA-based prostate cancer screening

In Germany, there is no official recommendation from experts for a general PSA-based prostate cancer screening. However, this could change in the near future. Two recent studies have shown that such screening appears to reduce the risk of mortality by 25 to 32 percent.

The scientists were able to observe during their examinations that a so-called mortality reduction of 25 to 32 percent can be observed in prostate screening. This could lead to a shift in thinking about PSA-based prostate cancer (PCa) screening. Up until now, North American specialist societies had mainly opposed such a screening.

Scientists have long been discussing the efficacy of so-called PSA-based prostate cancer screening. Recent results from studies have now led to a rethink. (Image: tashatuvango / fotolia.com)

Experts advocate organized, risk-adapted PCa screening

The new results have led the experts to favor organized and risk-adapted screening. At this year's congress of the German Society of Urology (DGU) in Dresden, the doctors advocated for a corresponding PCa screening, which is at best still financed by the statutory health insurance funds. This could be a form of rehabilitation for this form of treatment after North American societies have been largely negative about such a screening in the past.

Two large studies show positive results

U.S. Preventive Services Task Force has now upgraded the status of such a screening. This and other data from two important studies on the subject were the reasons for the optimism of the German urologists. Both the ERSPC and the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trials) had shown positive results.

Erroneous results in the PLCO study?

The large European study ERSPC had examined 180,000 subjects and found that a reduction in the so-called PCa-related mortality in screened men can be seen. American physicians initially had no benefit from the screening in the PLCO trial. In the spring of 2016, however, the experts explained that in reality, more than 80 percent of the participants in the non-screening group had participated in screening. So there was no real comparison between screening and non-screening in the PLCO study, which led to the conclusion that no different effects could be measured, the researchers explain.

Reduced risk of mortality was found in both studies

At the beginning of September, a joint evaluation of the data of the ERSPC and the PLCO studies was published. The results obtained in the analysis of the very complex statistics were clear, the researchers report. Both studies independently measured a reduced risk of mortality ranging between 25 and 32 percent.

Swedish scientists confirm the results

A Swedish study confirmed the findings by evaluating their study of men between the ages of early to mid-50 and subsequent medical surveillance of 18 years. The researchers found that the number of prostate cancer diagnoses doubled and the rate of prostate cancer metastases was halved. In addition, the rate of death from prostate cancer was reduced by 42 percent.

How can a carcinoma in need of treatment be reliably identified??

Urologists are of the opinion that PSA screening can extend life. The Swedish physicians calculated that if 139 men are screened and 13 carcinomas are detected, this can prevent a fatality within 18 years. Such a screening also detects many carcinomas that do not necessarily need to be treated. It is estimated that every second man needs no treatment, because the prostate cancer would not lead to death, explain the doctors. This raises the question of how those affected can be identified reliably with a carcinoma in need of treatment and so-called over-therapies are avoided.

Overdiagnosis and overtreatment must be avoided

It is important to monitor men better and operate less, say the experts. Overdiagnosis and overtreatment should be avoided at all costs. This could be achieved by an age restriction. If men are just 50 years of age and have a PSA level of less than 1 ng / ml, further screening is probably unnecessary. From the age of 70, such screenings do not seem to make sense either.

Recommendations of the German Society of Urology

The scientists of the German Society of Urology (DGU) recommend that a basic PSA from 45 years is carried out. If the observed values ​​are below 1 ng / ml, further controls should be performed every four years. At levels of 1 to 2 ng / ml, those affected should undergo such a check-up every two years, and at levels above 2 ng / ml, a check-up must be done every year. In addition, a so-called prostate cancer risk calculator should be used.

Effects of a positive finding on the psyche of those affected?

In the third quarter of 2016, about 3,000 insured persons had taken advantage of a prostate cancer screening test as part of a care concept by the AOK Baden-Württemberg. However, about half of all participants did not want to have their PSA detected. A total of 600 suspected cases were detected. A total of 91 biopsies were performed, in which two-thirds of the biopsies were positive. Such a positive finding can lead to considerable mental stress. It can cause and continue depression, anxiety and post-traumatic stress disorder. (As)