23.11.2018

Reappraisal of PSA tests. Urologists advocate determining baseline PSA levels with patients

The reappraisal of PSA tests that was the result of the PLCO 2016 study opened a new chapter in its changeable history. After the results of the study had been published, between times it was discovered that 90% of allegedly not tested patients, contrary to the study report, were tested and, if necessary, underwent treatment. In this regard, the study compared two groups that were equally often tested for PSA. “It’s not surprising that they couldn’t find any significant difference between these groups. These results, when reviewed with the revised analysis of the ERSPC, prompted a reappraisal of the PSA test values worldwide,” says General Secretary of the German Society of Urology (DGU), Professor Dr. Stefan Michel.

As part of the ERSPC, prostate cancer was detected in nearly 350 men out of 10,000 through the use of testing. So with the help of the PSA testing, it became possible to reduce mortality from prostate cancer by about 20% in the course of 13 years. However, despite the increased reputation, according to the current assessment of the DGU and the German Urology Professional Community (BDU), the PSA test remains a two-edged tool, the use of which should be weighed taking into consideration the benefits and the consequences. It should be the patient’s individual decision made after he has been fully informed by the urologist.

The time for the general advice to get a PSA test has not come yet,” said BDU President, Dr. Axel Schröder. Yet, German urologists have clear recommendations when it is necessary to discuss the PSA level in a patient who wants to be examined for early detection. “The so-called baseline PSA level between the ages of 40 and 45 provides useful information about individual risks of getting prostate carcinoma sometime in the future. It is necessary to respond appropriately depending on this level, especially if prostate cancer has already been found in younger men in the family,” says DGU President, Professor Dr. Tilman Calble. The control intervals which can be up to five years long and which can save lives also depend on this state of things. Along with the testing of the baseline PSA level, the analysis at the age of 55 to 70 shows the possibility of reducing the risk of unnecessary treatment.

The United States Preventive Services Task Force (USPSTF) special committee is of the same opinion. It questions its negative judgments of 2012. Thus, the risks and benefits are almost balanced; men between the ages of 55 and 69 should decide on the PSA test together with their doctor.

The claim that PSA tests should be paid for by the health insurance funds is not set up by the trade communities. The DGU, BDU and the Prostate Cancer Patient Support Organization (BPS) share the view that it is necessary to wait until the evidence base becomes so convincing that the chances of a positive decision by the Federal Joint Committee (G-BA) will be quite high. “Until then, we are going to continue working together on public perception and objective assessment of PSA levels, as well as further exploring alternative methods of prostate carcinoma early detection,” said DGU Spokesman, Professor Dr. Christian Wulfing.

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