PSA test for precautionary prostate cancer controversial

PSA test as a precautionary measure against prostate cancer

09/23/2014

Prostate cancer is the most common cancer in German men and the third most common cause of cancer death. The number of new cases is increasing. In the legal screening program a palpation examination is provided. Not included is the so-called PSA test, a special blood test. This test is considered controversial.

Most common cancer in German men
In Germany, prostate cancer is the most common cancer in men and the third most common cause of cancer death. According to the Robert Koch Institute (RKI), the number of new cases has increased in recent years. From the age of 45 years, men in Germany have the option of prostate cancer screening as part of the statutory screening program. Here, the scanning of the genitals and the associated lymph nodes are provided in the groin. In addition, the prostate is scanned from the rectum. Not included, however, is the PSA test, a special blood test that must be paid by the patients themselves. This test is considered controversial.

Screening leads to unnecessary treatments
In this study, a blood sample is tested for the concentration of an enzyme from the prostate gland, the „prostate-specific antigen“, examined. A high score may indicate prostate cancer, but it does not have to. For example, researchers recently reported in the journal „The Lancet“, that many healthy people would only become cancer patients through a blood test. The screening would therefore lead to unnecessary treatments and would have prevented in 800 men only a death from prostate cancer.

Over-treatment of healthy cheaper for health care system
The director of the Department of Urology of the Saarland University Hospital, Michael Stöckle, finds it after the „Lancet“-This study disappointingly shows that the protective effect of PSA screening does not increase even after a few years. Nevertheless, he is in favor of allowing younger men to be tested. Even a drastic over-treatment of healthy people for elevated levels of PSA may be cheaper for the health care system than fighting cancer at a late stage. But critics say that the PSA test is too unspecific and does not detect every tumor.

Early treatment is not recommended
However, if a cancer is actually diagnosed, for example by a biopsy in which tissue samples are taken surgically, the further treatment method remains debatable. So there are a few doctors who advise against prostate cancer in the early stages of treatment and think the cancer for the time being „actively monitored“ become. Only when it grows demonstrably, should intervene. Among the advocates of this waiting is also the Berlin urologist Lothar Weissbach. According to the „world“ he said: „In Germany, too much surgery is done.“ Many patients would not know that prostate cancer is life-threatening for only a few people. Hospitals would earn several thousand euros per procedure for prostate treatment.

Every eighth prostate cancer surgery life-saving
The German Society for Urology defends itself against such criticism. Weissbach's statements would not be proven by his own study. But other studies come to critical results. For example, a long-term study from Sweden shows that only every eighth prostate cancer surgery is life-saving. Michael Stöckle, a urologist at the University of Saarland, hopes that new tests will be developed in the future that can more accurately distinguish between dangerous and harmless tumors. The disadvantages of surveillance, such as palpation and blood sampling, which take place quarterly and possibly to the end of life, are unpleasant, as Weissbach said. In addition, in some patients up to four biopsies should be done. In some cases, the procedure may lead to sepsis or damage nerves that are important for potency.

Surgery often leads to incontinence and impotence
In addition, waiting in some patients can lead to a fatal course of the cancer. The psychological stress can be very high. Patients who opt for surgery will partially or completely remove the prostate. However, this procedure can not always stop the cancer and often leads to incontinence or impotence. Although the method has improved in recent years, more than half of the men lose their potency after the removal of the prostate. This depends on the size of the tumor. „Where you can operate to sustain your potential, you might not even have to operate“, so Stöckle.

Irradiation is only chosen by a few Germans
Another route is irradiation, which, according to Thomas Wiegel, director of the Department of Radiotherapy and Radiooncology at Ulm University Hospital, is rarely chosen here. „The Germans are friends of cutting something, that gives them security.“ This method has also been improved in recent years and has a similar chance of success as the surgeries. No matter which treatment is used: In general, the sooner the stage in which it is found, the better a tumor can be treated.

Lower the risk of death from prostate cancer
A very positive assessment of the screenings came only recently from a European long-term study. The „European Randomized Study of Screening for Prostate Cancer“ (ERSPC), which was launched in eight European countries in 1993, came to the conclusion that the PSA test reduces prostate cancer mortality by up to 20 percent. Prof. Peter Hammerer from the Association of Urological Oncology had to a few weeks ago to the „dpa“ explains that although the screening is not a perfect test, it can help to assess risks. Above all, it was important that the men were informed about the advantages and disadvantages in order to assess the validity of the test. (Ad)