The prostate, also known as the prostate gland, is located deep in the male pelvis, is about the size of a chestnut and normally weighs around 20 grams. In addition to prostate cancer , benign prostate enlargement (prostatic hyperplasia) and prostate inflammation (prostatitis) are among the most common prostate diseases.
Prostate cancer is the most common type of cancer in men in Germany. Every year, around 65,000 men are diagnosed with this disease. However, prostate cancer is easily treatable. To detect prostate cancer at an early stage, preventive physicians have several procedures to choose from. Specialists in the diagnosis and treatment of prostate diseases are urologists, andrologists and radiation oncologists.
©bilderzwerg / AdobeStockThe statutory cancer screening for men includes a palpation examination of the prostate from the rectum. The PSA test, on the other hand, is an optional examination method if further prostate diagnostics are desired. The PSA concentration in the blood serum can be measured with a simple blood sample.
As the prostate reacts to pressure, it is not advisable to carry out a PSA test directly after a prostate palpation. The value then determined could be falsified by the palpation examination.
Whether cycling influences the results of a PSA test has not been clarified beyond doubt. To ensure that false positive values are not measured, it is generally recommended not to cycle in the 24 hours before the PSA test. The extent to which sexual intercourse or ejaculation affects the test result is also unclear. The PSA value in the blood can therefore fluctuate due to various factors.
Taking a blood sample for the PSA test is harmless and low-risk. However, men who opt for a blood test to determine the PSA value should be aware that the doctor may suggest a biopsy as a further examination step. If the value is elevated, psychological stress must also be expected: Waiting until a new test can be carried out to confirm or refute the suspicion can have a significant impact on enjoyment of life.
©jarun011 / AdobeStockThe use of the PSA test for the comprehensive early detection of prostate cancer is controversial in Germany and also in the USA, because it has not been proven that men who have it carried out regularly live longer or better and therefore the benefits of this examination for early detection have not been established beyond doubt (see Cancer Information Service).
PSA test to check for prostate cancer
However, if a man has already developed prostate cancer, the PSA test is a standard procedure for monitoring the progress of prostate cancer (recurrence detection). If the PSA value has initially fallen after prostate cancer treatment and then rises again, it is suspected that the prostate cancer has returned.
For men who have an increased risk of prostate cancer due to a higher incidence of prostate cancer in their family, a regular PSA test may be advisable from the age of 40. This should be discussed with your doctor.
The normal range of the PSA value depends on the age of the patient; the value increases with increasing age.
If the PSA value rises above two or even four nanograms per milliliter (ng/ml) of blood, the causes should be investigated or the patient should be monitored relatively closely.
What happens when PSA levels are elevated?
In addition to a carcinoma, an elevated PSA value can also be caused by comparatively harmless inflammation or simply increased stress on the pelvic region (e.g. through sport). To further narrow down the type of disease, the ratio of the so-called free PSA in relation to the total PSA present can be examined (PSA quotient). If the value is elevated several times and over a longer period of time, the suspicion of cancer should be clarified by taking a tissue sample (biopsy).
A single elevated PSA value does not justify a cancer diagnosis. If the PSA value has been elevated several times over several weeks or months and the palpation examination has also revealed abnormalities, a tissue sample (biopsy) should be taken. Under the microscope, it can be seen whether the cells are cancerous. In three quarters of all men with elevated PSA values, no carcinoma is detected in the tissue sample.
As prostate cancer often only occurs at an advanced age and does not always cause symptoms, it is questionable whether the PSA test is of sufficient benefit to make it worth worrying men with elevated PSA levels. And: men may be turned into cancer patients even though they would not have suffered any restrictions in their quality of life or a shortening of their lifespan as a result of the carcinoma.
As some particularly aggressive prostate tumors only show slightly elevated PSA values, false negative results can also occur. 15 percent of malignant prostate tumors are not associated with elevated PSA levels (see Prostate Help Germany). Therefore, a low PSA value does not necessarily mean that a man does not have prostate cancer.
These concerns and considerations are the reason why there is no comprehensive prostate cancer screening in Germany using PSA samples, although the PSA test can be helpful in the early detection of prostate cancer.
