The PSA Test and Prostate Cancer: How Reliable Is It?

The advantages of the blood test for the early detection of prostate cancer have given rise to controversy. Urologists advise against stigmatising the PSA test.

Dr. Schiefelbein warns against devaluing the PSA test, as it is still the most sensitive parameter for early detection of prostate cancer.

The Institute for Quality and Efficiency in Health Care (IQWiG) recommended that statutory health insurance companies not offer or reimburse PSA screening due to the harm it can cause, such as overdiagnosis, overtreatment, and false-positive results.

The American Urological Association demands a PSA test as a health insurance benefit.

The BDU advocates for the approval of the PSA test as a health insurance benefit due to its effectiveness in detecting cancer and minimising the risk of dying from prostate cancer.

The utility value is determined by the individual’s risk profile.

Schiefelbein, a Würzburg urologist, points to the study “European Randomized Study of Screening for Prostate Cancer” (ERSPC) which suggests that the PSA test can reduce mortality from prostate cancer by up to 21 percent and reduce the risk of metastases by up to 42 percent. However, the expert advocates “risk-adapted prostate screening” which takes into account a man’s individual risk profile for prostate cancer, such as an elevated PSA level between the ages of 40 and 45 and if prostate cancer runs in the family. 

For men with a low baseline PSA level at the age of 40 or 45, no family risk and no abnormal physical examination findings, the next check-up may not be necessary for three or five years or more. In men with a family risk, closer monitoring is important.

Prostate cancer: the most common cancer in men

Prostate cancer is the most common type of cancer in men, with 66,900 diagnosed in Germany. Early detection is important, as carcinomas often go undetected for a long time, but are easily curable in the early stages. The examination by the urologist includes rectal palpation of the prostate and genitals, but a tumour that is discovered by palpation is usually more advanced and has a poorer chance of healing.

Dr. Wolfgang Bühmann, urologist and spokesman for the Professional Association of German Urologists (BDU), warns against diagnosing prostate cancer too late. It is possible to have a blood test done in addition to the palpation to determine the PSA value, but the procedure is controversial as it can lead to a short-term increase due to benign prostate enlargement, inflammation, urinary tract infection, or sex and sport. The meaningfulness of the value is not reliable.

What is the PSA value?

PSA is a protein produced by the prostate and released into the semen. It is found in healthy men in small amounts, but increases in prostate cancer.

PSA test as an indicator of prostate disease

PSA levels can be determined by a blood test, which can indicate prostate disease, such as benign hyperplasia or benign inflammation. Prostate carcinoma can also be indicated by an increased PSA value, and further investigations may be initiated.

PSA value in ng/mljudgement
0-2unremarkable, check-up after two years
2-4in need of clarification, control after one year
over 4Tissue sample recommended

How safe is the PSA test?

The PSA test is an important diagnostic method for early detection of prostate cancer, but its result must be viewed in relation to other studies. Healthy men have a PSA level of 0-4 nanograms per milliliter of blood, but if it increases by more than 0.75 nanograms per milliliter of blood each year, a tissue sample is usually taken. This is the only way to determine with certainty whether it is prostate cancer.

“Prostatakrebs: Wie Sicher Der PSA-Test Wirklich Ist.”, 3 Mar. 2011,



4th Professional Medical Student. Karachi Medical and Dental College.

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