German Society of Urology (DGU) calls for risk-adapted, PSA-based prostate cancer screening: Pros and cons of the test

19.08.2025

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Leading Medicine Guide Editors

In Germany, prostate cancer is the most common type of cancer in men. The mortality rate is also high: it is considered the second most common cause of cancer-related death among men. Currently, statutory health insurance only covers digital rectal examinations for men between the ages of 45 and 65 as part of early detection. The German Society of Urology (DGU) calls for risk-adapted, PSA-based screening (blood test) to diagnose the disease at an early stage in high-risk patients and to improve their chances of recovery.

High-risk patients may benefit from PSA testing as a standard diagnostic tool for prostate cancer

Current prostate cancer screening services

At present, statutory health insurers cover one digital rectal exam per year with a urologist, provided the patient is at least 45 years old.

During this examination, the prostate is palpated via the rectum. While not painful, some still find it unpleasant. If the specialist detects changes, further examinations such as a biopsy are initiated – sometimes preceded by a PSA test.

For several years, physicians and cancer societies have considered prostate cancer screening using only palpation insufficient, since this method cannot detect marginal tumors and can lead to misdiagnosis and overtreatment. The German Society of Urology therefore appeals to the Federal Ministry of Health to introduce risk-adapted, PSA-based screening as a standard service covered by statutory health insurance. To date, patients still have to pay for a PSA test out of pocket.

Chances of curing prostate cancer

If detected early, prostate cancer has very good chances of being cured. However, this remains a problem: relying solely on palpation is often too imprecise, and prostate cancer can remain unnoticed for a long time, as it typically causes symptoms only at a late stage.

Curing the disease at an advanced stage is only possible in rare cases.

Pros and cons of the PSA test

In a PSA test, a blood sample is used to measure the concentration of prostate-specific antigen (PSA), a protein responsible for liquefying semen. This protein is only found in the prostate. An elevated value may indicate prostate cancer.

The rule of thumb is: The higher the PSA value, the higher the probability of prostate cancer. However, caution is required, since elevated values can also result from benign prostate enlargement, inflammation, or urinary tract infections. Therefore, a single abnormal value should not immediately trigger further diagnostic measures, but should always be confirmed by additional tests.

Conversely, a value within the normal range does not definitively rule out prostate cancer.

Studies have shown that prostate cancer is detected more frequently in men undergoing PSA screening than in those without blood tests. However, this affected only about three out of 1,000 men over a period of roughly twelve years.

Risk-adapted screening – what does it mean?

Research suggests that it is not advisable to offer every man between the ages of 45 and 65 an annual PSA test as a standard procedure, as misdiagnoses and overtreatment can cause significant harm to patients and to the healthcare system.

Instead, according to medical societies, doctors should first establish individual risk profiles for patients. Key risk factors include genetic aspects, such as a family history of prostate cancer or breast cancer in the mother.

In some men, an elevated PSA value already between the ages of 40 and 45 may indicate an aggressive form of prostate cancer.

In such cases, offering the test as a standard service under statutory health insurance seems appropriate. However, even then, physicians are responsible for providing patients with detailed information about the advantages and disadvantages of the test as well as its consequences. Experts also recommend that screening intervals be adapted to the patient’s individual situation.

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

In 2014, the German Cancer Research Center launched the PROBASE study, involving 46,642 men aged 45 or 50, depending on their risk profile, who underwent PSA tests every two or five years. The study will continue until all participants have reached the age of 60.

So far, the study has shown that digital rectal examinations are insufficient and often inaccurate, while PSA diagnostics combined with modern techniques such as MRI deliver better results. Additional findings are still pending.

Conclusion

For high-risk patients, regular PSA testing appears to be a meaningful preventive measure to detect malignant prostate cancer at an early stage. However, a single elevated result should always be confirmed by further testing before proceeding to additional diagnostics such as biopsies, which may have far-reaching consequences for patients.

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

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