PSA test.

The PSA level is an indicator of prostate cancer, although it is not a conclusive symptom.

PSA is an abbreviation of “Prostate-Specific Antigen”, a protein that is formed in the prostate and released into the semen. The PSA level is important in the early detection of malignant diseases of the prostate. If the level is elevated, it may be an indicator of prostate cancer. However, an elevated PSA level is not a definitive test for prostate cancer; at most it is a warning sign. Further investigations—such as a biopsy, i.e. the removal and examination of a tissue sample—are necessary to make a firm diagnosis.

However, it should be noted that determining the PSA level is of great importance in the early detection of prostate cancer.

What conclusions can be drawn from the PSA level?

How is the PSA level determined? PSA is a protein that is only detectable in small quantities in the blood. It can be measured by taking a blood sample and performing a subsequent laboratory analysis. The higher the PSA level that is measured, the more likely it is that a malignant disease of the prostate is the cause. However, it is important for patients to know that there are also benign diseases that are associated with elevated PSA levels. These include prostate enlargement and inflammation of the prostate or urinary tract. Statistically, around seven out of ten patients with a slightly elevated PSA level do not have prostate cancer. [1] As part of the screening process, doctors must explain the PSA test and the advantages and disadvantages associated with it. This is due to the risk of overdiagnosis and overtreatment.

Advantages and disadvantages of measuring the PSA level as part of prostate screening

What is overdiagnosis? Not every case of prostate cancer found during early detection screening requires treatment. In some circumstances and to a lesser extent, PSA measurements can reveal tumours that, without screening, would not have been detectable during the men’s lifetime. This is because in its less malignant and less aggressive form, prostate cancer can remain undetected for many years without spreading, and therefore not cause any impairment or even become life-threatening. This is estimated to be the case in approximately 40 out of 1000 men [2]. The PSA level is constantly at the centre of scientific discussions about whether measuring the PSA level leads to men being given unnecessary oncological treatment. At the same time, however, the benefits of prostate screening including a PSA test remain uncontested, as it contributes to the early diagnosis of prostate cancer at a stage when it is still easily treatable. Your urologist can answer any questions you may have relating to PSA levels.

[1] Deutsche Krebshilfe (German Cancer Aid): Blauer Ratgeber 17 (Blue advice booklet no. 17). Prostatakrebs – Antworten.Hilfen.Perspektiven. (Prostate cancer – Answers.Help.Prospects.) Bonn 2016, page 14.
[2] ibid., p. 15

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