The prostate, also known as the prostate gland, is located deep within the male pelvis; it is about the size of a chestnut and typically weighs about 20 grams. In addition to prostate cancer, benign prostate enlargement (benign prostatic hyperplasia) and prostate inflammation (prostatitis) are among the most common prostate conditions.
Prostate cancer is the most common type of cancer among men in Germany. Every year, approximately 65,000 men are diagnosed with this disease. However, prostate cancer is highly treatable. For the early detection of prostate cancer, primary care physicians have several methods to choose from. Specialists in the diagnosis and treatment of prostate diseases include urologists, andrologists, and radiation oncologists.
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Statutory cancer screening for men includes a digital rectal exam of the prostate. The PSA test, on the other hand, is a voluntary screening method for those who wish to undergo further prostate diagnostics. A simple blood sample can be used to measure the PSA concentration in the blood serum.
Since the prostate reacts to pressure, it is not advisable to perform a PSA test immediately after a digital rectal exam. The resulting value could be skewed by the exam.
It is not definitively clear whether cycling affects the results of a PSA test. To ensure that false-positive results are not obtained, it is generally recommended to avoid cycling in the 24 hours prior to the PSA test. It is also unclear to what extent sexual intercourse or ejaculation affects the test result. The PSA level in the blood can therefore fluctuate due to various factors.
The blood draw for the PSA test is harmless and carries little risk. However, men who decide to have a blood test to determine their PSA level should be aware that the doctor may recommend a biopsy as a further step in the examination. If the level is elevated, psychological stress must also be expected: Waiting until a new test can be performed to confirm or rule out the suspicion can significantly impair one’s quality of life.
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The use of the PSA test for widespread early detection of prostate cancer is controversial in Germany and the U.S. because there is no evidence that men who undergo it regularly live longer or have better quality of life, and thus the benefit of this test for early detection has not been conclusively established (see Cancer Information Service).
PSA Test for Follow-Up After Prostate Cancer
If, on the other hand, a man has already been diagnosed with prostate cancer, the PSA test is a standard procedure for monitoring the course of the disease (to detect recurrence). If, following prostate cancer treatment, the PSA level initially drops and then rises again, there is a suspicion that the prostate cancer has returned.
For men who are at increased risk of prostate cancer due to a family history of the disease, regular PSA testing starting at age 40 may be advisable. This should be discussed with a doctor.
The normal range for PSA levels depends on the patient’s age; levels tend to rise with age.
If the PSA level rises above two or even four nanograms per milliliter (ng/ml) of blood, the causes should be investigated, and the patient should be monitored relatively closely.
What happens if the PSA level is elevated?
In addition to cancer, an elevated PSA level can be caused by relatively harmless inflammation or simply increased strain on the pelvic region (e.g., from exercise). To further narrow down the type of condition, the ratio of so-called free PSA to total PSA can be examined (PSA ratio). If the level remains elevated on multiple occasions and over an extended period, the suspicion of cancer should be investigated through a tissue sample (biopsy).
A single elevated PSA level does not in itself constitute a diagnosis of cancer. If the PSA level has been elevated on multiple occasions over several weeks or months and a digital rectal exam has also revealed abnormalities, a tissue sample (biopsy) should be taken. Under a microscope, it is possible to determine whether the cells are cancerous. In three-quarters of all men with elevated PSA levels, no cancer is detected during the biopsy.
Since prostate cancer often does not develop until old age and does not always cause symptoms, it is questionable whether the PSA test offers sufficient benefit to justify causing anxiety in men with elevated PSA levels. Furthermore, men may be labeled as cancer patients even though the cancer would not have impaired their quality of life or shortened their lifespan.
Since some particularly aggressive prostate tumors show only slightly elevated PSA levels, false-negative results can also occur. Fifteen percent of malignant prostate tumors are not associated with elevated PSA levels (see Prostata Hilfe Deutschland). Thus, a low PSA level does not necessarily mean that a man does not have prostate cancer.
These concerns and considerations are the reason why there is no nationwide prostate cancer screening program using the PSA test in Germany, even though the PSA test can be helpful in the early detection of prostate cancer.
