Early detection of prostate cancer: No more urologist finger in the butt!

In view of the data situation, the new doctor’s line to prostate cancer, according to which the tactile test is to be expired and the PSA test is to be strengthened: no test on prostate cancer has now been researched as well as the PSA examination in the blood. The diagnostic value of the key with the index finger in the butt, on the other hand, is how a large international overview study showed again. Accordingly, it is to be welcomed if men are offered more sensible early detection from the doctor in the future. According to the guideline design, this should also be tailored to the individual man.

The draft guidelines under the leadership of the German Society for Urology could set up completely new rules for early cancer detection for men aged 45 and over. The unpleasant tactile examination is no longer recommended, in which a urologist introduces his index finger into the patient’s rectum in order to feel ulcers of the prostate. So far, this investigation has been standard for men aged 45 and over and is paid for by statutory health insurance companies as early detection. It is inaccurate and only recognizes tumors when they are already quite large – that is: Maybe too late for gentle and successful therapy.

Instead of scanning, men aged 45 and over should be offered in the future-after advice-a PSA test in the blood. An increased PSA value can indicate prostate cancer. So far, however, the test has to be paid out of your own pocket (except for specific suspicion of cancer) and costs around 50 euros. This could change by the new guideline in the medium term. It should also increase the pressure on the Federal Joint Committee. The committee decides which services – including which early detection methods – reimburse statutory health insurance. Although a decision about the PSA test on cash costs instead of the tactile examination, a decision could probably be drawn for years, but it has now been postponed.

The PSA or prostate-specific antigen is a protein that is formed in the prostate and diluted the seed fluid so that the sperm comes to the egg cell. It also circulates in the blood because the prostate is crossed by many veins. In order to determine the PSA value, blood is removed from the arm in the doctor’s office and examined for PSA protein in the laboratory. So far, a value of less than three nanograms (billionth grams) per milliliter of blood is usually considered inconspicuous. With two measurements of more than four nanograms or when the value increases, a so -called needle biopsy from the intestine is often made: around ten tissue pieces are punched out of the prostate with small hollow needles, and the cells are then examined under the microscope for cancer.

Now the PSA test is not perfect either. Many factors can increase the blood value without anyone being ill: ejaculation, inflammation of the prostate and even cycling. Unfortunately, this often leads to unnecessary and painful tissue withdrawals and further examinations. In addition, an increased PSA value causes worries if you suddenly feel like a possible cancer or even death candidate.

What is still complicated: Even if cancer is actually found during further examinations, not every man has to be treated with prostate carcinoma. Some tumors grow so slowly that they do not cause any problems even in old age. You die with them, not from them. They lovingly call urologists “pet cancer” because the body houses them like a tame animal. Others fall over their host like a predator, form metastases in other parts of the body and can kill a man in a short time. Anyone who carries a “pet” and whoever has a “predator” can hardly be predicted at first. This leads to the fact that men are repeatedly removed the prostate – with possible side effects such as permanent impotence or incontinence – for which this was not necessary.

Therefore, in the past, it has often been fierce for the benefits and damage of the PSA test. Some saw it the only functioning early detection, others argued that the blood test would cost a lot of money and men who did not need diagnosis or treatment to stamp to cancer patients. Even the discoverer of PSA protein, the US Cancer researcher Richard Ablin, vowed vehemently against a PSA routine examination in 2013.

However, further major studies on the most relevant early detection question have been completed: a comprehensive PSA screening actually prevents prostate cancer deaths? In the large European SPC study, tens of thousands of men could be removed for PSA tests for years. Her medical history has been followed for more than 15 years-with the result that a PSA screening can apparently prevent some cancer deaths. Out of 1000 scattered men, three less of prostate cancer died in the period. However, 14 men with “overdiagnosis” came in every prevented death: after a PSA test, a “tame” prostate cancer was diagnosed that would never have caused any problems. So these men had disadvantages through the test – but no fatal ones.

Many others could take care of a PSA test: it provides good information on how high the risk of prostate cancer in the next few years: recent data from the big Germans of more than 20,000 men show that men with a very low PSA value is most likely on the safe side: After that, men who had a PSA value below 1.5 nanogram per milliliter have only a very low risk in the next five years, in the next five years To develop prostate cancer. Middle high was the danger at a value up to three nanograms, high at three or more.

The newly designed guideline should also take into account this difference: Men with PSA value below 1.5 nanograms should in future come to blood control every five years, men with a value of up to three nanograms every two years. And if you are more than three nanograms more than once, you should continue to be examined: For example, it is asked about cancer in the family, measured the prostate by ultrasound and possibly arranged an MRI (KERSPIN) of the prostate. An MRI can provide further information as to whether it is a dangerous tumor. Only then would the needle biopsy be used.

With PSA test and additional examinations instead of finger scanning, the risk for the individual patient could be calculated more precisely-before radicals and possibly unnecessary treatments such as an operation follow the prostate. There is hope that more dangerous tumors will be discovered and less irrelevant over Therapy. In this respect, the revision of the medical guideline is progress. It is to be hoped that the legal health insurers will react to it.