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Experts are changing their minds about PSA-based prostate cancer screening
So far, there is no official recommendation from experts for general PSA-based prostate cancer screening in Germany. However, this could change in the near future. Two recent studies have shown that such screening appears to reduce the mortality risk by 25 to 32 percent.
The scientists were able to observe in their investigations that a so-called mortality reduction of 25 to 32 percent can be found in prostate screening. This could lead to a rethink about PSA-based prostate cancer (PCa) screening. Up to now, North American specialist societies had mostly spoken out against such screening.
Experts advocate organized, risk-adapted PCa screening
The new results meant that the experts are now advocating organized and risk-adapted screening. At this year's congress of the German Society of Urology (DGU) in Dresden, the medical practitioners advocated appropriate PCa screening, which at best is still financed by the statutory health insurance companies. This could be a kind of rehabilitation for this form of treatment, after North American specialist societies had mostly negatively expressed such screening in the past.
Two large studies show positive results
The U.S. Preventive Services Task Force has now upgraded the importance of such screening. This and other data from two important studies on the subject were the reasons for the optimism of German urologists. Both the ERSPC (European Randomized Study of Screening for Prostate Cancer) and the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial) had shown positive results.
Incorrect results in the PLCO study?
The large European study ERSPC had examined 180,000 subjects and found that a reduction in the so-called PCa-related mortality was observed in men screened. American physicians initially found no benefit in screening in the PLCO study. In spring 2016, however, the experts explained that in the non-screening group, more than 80 percent of the participants had actually taken part in a screening. So there was no real comparison between screening and non-screening in the PLCO study, which meant that no different effects could be measured, the scientists explain.
Reduced risk of mortality was found in both studies
At the beginning of September a joint evaluation of the data from the ERSPC and the PLCO studies appeared. The researchers found that the results obtained when evaluating the very complex statistics were clear. In both studies, a reduced risk of mortality could be measured independently, which was between 25 and 32 percent.
Swedish scientists confirm the results
A Swedish study confirmed the results by evaluating their study of men in their early to mid-50s and subsequent medical surveillance for 18 years. The scientists found that the number of prostate cancer diagnoses doubled and the rate of prostate cancer metastases halved. In addition, the rate of death from prostate cancer was reduced by 42 percent.
How can a cancer requiring treatment be reliably identified?
Based on the results, urologists believe that PSA screening can extend life. Swedish physicians calculated that if 139 men take part in a screening and 13 carcinomas are found, it can prevent a death within 18 years. Such screening also detects many carcinomas that do not necessarily need to be treated. It is estimated that every second man does not need treatment because the prostate cancer would not lead to death, the doctors explain. So the question arises of how those affected with cancer requiring treatment can be reliably identified and so-called over-therapies avoided.
Overdiagnosis and over therapy must be avoided
It is important to monitor men better and do less surgery, the experts say. Overdiagnosis and over therapy should be avoided. This could be achieved through an age restriction. If men are just before 50 years of age and have a PSA of less than 1 ng / ml, further screenings are probably no longer necessary. From the age of 70, such screenings also no longer seem to make sense.
Recommendations of the German Society for Urology
The scientists of the German Society for Urology (DGU) recommend that a basic PSA is carried out from the age of 45. If the values found are below 1 ng / ml, further checks should be carried out every four years. At values of 1 to 2 ng / ml, those affected should have such a check-up carried out every two years, and at values over 2 ng / ml, an examination must even be carried out annually. In addition, a so-called prostate cancer risk calculator should be used.
Effects of a positive finding on the psyche of those affected?
In the 3rd quarter of 2016, around 3,000 insured persons had an early prostate cancer screening as part of a care concept from the AOK Baden-Württemberg. However, around half of all participants did not want to have their PSA determined. A total of 600 suspected cases were identified. A total of 91 biopsies were performed, in which two thirds of the biopsies were positive. Such a positive result can lead to considerable psychological stress. Depression, anxiety and post-traumatic stress disorder can develop and continue. (as)