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The German Society of Urology (Deutsche Gesellschaft für Urologie e. V.) Calls for Risk-Adapted, PSA-Based Prostate Cancer Screening: Advantages and Disadvantages of the Test

Sabine Schneider · August 19, 2025

In Germany, prostate cancer is the most common form of cancer among men. The mortality rate is also high: it is considered the second leading cause of cancer-related deaths among men. Currently, the only early detection services covered by health insurance are digital rectal exams for men between the ages of 45 and 65. The German Society of Urology (Deutsche Gesellschaft für Urologie e. V.) is calling for risk-adapted, PSA-based screening (blood test) to enable early diagnosis of the disease in high-risk patients and to increase the chances of recovery for those affected.

High-risk patients can benefit from the PSA test as a standard service in the diagnosis of prostate cancer

Current Prostate Cancer Screening Coverage

Currently, statutory health insurance plans cover a digital rectal exam by a urologist once a year, provided the patient is at least 45 years old.

During the examination, the prostate is palpated through the rectum; while this is not painful, some patients still find it uncomfortable. If the specialist detects any abnormalities, he or she will order further tests, such as a biopsy—and, if necessary, a PSA test beforehand.

For several years now, doctors and cancer societies have considered the current diagnostic approach for the early detection of prostate cancer to be insufficient, as this method fails to detect peripheral tumors and can lead to misdiagnoses and overtreatment. The German Society of Urology (Deutsche Gesellschaft für Urologie e. V.) is therefore calling on the Federal Ministry of Health to introduce risk-adapted, PSA-based screening as a standard benefit covered by statutory health insurance. Until now, patients have had to pay for a PSA test out of their own pockets.

Chances of Recovery from Prostate Cancer

If prostate cancer is detected early, the chances of a cure are very good. But this is precisely where the problem lies: Diagnosis based solely on a digital rectal exam is often too imprecise, and prostate cancer can go undetected for a long time because symptoms do not appear until the disease is advanced.

A cure in later stages is achieved only in rare cases.

Advantages and Disadvantages of the PSA Test

The PSA test involves taking a blood sample to measure the concentration of the so-called prostate-specific antigen (PSA), a protein that helps liquefy semen. This protein is found only in the prostate. An elevated level may indicate prostate cancer.

As a general rule, the higher the PSA level, the greater the likelihood of prostate cancer. However, caution is advised when interpreting these results, as elevated levels can also be caused by other conditions, such as benign prostate enlargement, prostatitis, and urinary tract infections. Therefore, a single abnormal result should not immediately lead to further diagnostic tests but should always be confirmed by additional measurements.

Conversely, a value within the normal range is not conclusive proof that prostate cancer is absent.

Studies have shown that prostate cancer is detected more frequently in men who undergo PSA screening than in those who do not have a blood test. However, on average, this affected only three out of every 1,000 men over a period of about twelve years.

Risk-adapted screening—what does that mean?

The studies suggest that it does not make sense to automatically offer an annual PSA test to every patient between the ages of 45 and 65 across the board, as misdiagnoses and overtreatment can cause immense harm to patients and the healthcare system.

Instead, according to professional societies, doctors should first create individual risk profiles for patients. Major risk factors include, for example, genetic factors such as a family history of prostate cancer or breast cancer in the mother.

In some men, an elevated PSA level as early as ages 40 to 45 may also indicate an aggressive form of prostate cancer.

In these cases, the test appears to be a reasonable standard benefit covered by statutory health insurance, but even here, it is the responsibility of doctors to thoroughly explain the pros and cons of the test and its consequences in advance. Experts suggest that screening intervals should also be tailored to the patient’s individual situation.

The PROBASE study by the German Cancer Research Center aims to provide further answers

In 2014, the German Cancer Research Center launched the PROBASE study, in which 46,642 men aged 45 or 50 and older, depending on their risk profile, undergo PSA tests every two or five years. The study is set to continue until all participants have reached the age of 60.

So far, the study has shown that digital rectal examination is insufficient and often inaccurate, whereas PSA testing, when combined with modern techniques such as MRI, yields better results. Further findings are still pending.

Conclusion

For high-risk patients, regular PSA testing appears to be a sensible preventive measure for the early detection of malignant prostate cancer. However, a single elevated reading should always be confirmed by further tests before proceeding with more invasive procedures, such as biopsies, which may have far-reaching consequences for patients.

You can obtain comprehensive information about the PSA test from the specialists in the Leading Medicine Guide, who can also provide treatment recommendations in the event of a prostate cancer diagnosis.