The PPE is worth it

PSA value: why it is worth knowing

Hardly any other topic is currently causing as much discussion as the PSA test for the early detection of prostate cancer. American experts had advised against it in 2012 after the large PLCO study ("Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial"): Men would not benefit from it, according to the result. But at the same time the second large ERSPC study ("European Randomized Study of Screening for Prostate Cancer") from Europe had shown the opposite: Thanks to the test, fewer men died, according to the result. So what's the truth? In a new evaluation of the PLCO study it became clear: the researchers had worked sloppily, which is why the results were misinterpreted.

The Europeans are right. According to new analyzes, mortality is falling by more than half. "The PSA test is great," says Markus Graefen, urologist at the prostate cancer center at the University Clinic Hamburg-Eppendorf. "But only if you use it in the right situation and interpret it correctly." When he heard at a congress last year how the PLCO study had been carried out, he was stunned. 90 percent of those who were allegedly not tested did have themselves tested - in total even more men than in the PSA group. "So the study compared two groups in which the test was performed almost equally," he explains. No wonder no difference in mortality was found. "With the mish-mash, the colleagues should not have drawn any conclusions or published the study."

American sloppiness

After all, some of the PLCO researchers seemed to have seen their sloppiness, because they helped with the new evaluation. "I thought it was great that my colleagues decided to do this," says Maciej Kwiatkowski, urologist at the Cantonal Hospital in Aarau, Switzerland and also one of the authors of the new study. "I think the head of the study underestimated the effects it can have if the two groups are not properly separated from each other."

In the nine-year ERSPC study, the PSA test resulted in a 21 percent reduction in mortality. But what does that mean? 1410 men had to be invited to PSA tests and 48 prostate cancers diagnosed in order to save one man's life.

"The longer the studies, the more the test seems to be worthwhile," says Graefen. According to the 14-year sub-study of the ERSPC study from Sweden, 293 men must be invited to the test and twelve cancers diagnosed in order to prevent one death, which corresponds to a risk reduction of 44 percent. In the 13-year partial study from the Netherlands, the risk was even reduced by more than half. Of 34,833 study participants, 15,428 took the test as intended, of which 42 ultimately died of prostate cancer. Twice as many of the 15,381 untested died, namely 78. If you convert the data to a lifelong observation, only 98 men would have to be invited and five cancers diagnosed so that one man's life could be saved.

From 45 it makes sense

There is no general recommendation for PSA screening. "The PSA test is the only way to detect prostate cancer in a curable stage," says Stephan Madersbacher, urologist at the Kaiser-Franz-Josef-Spital in Vienna. He recommends a first test between the ages of 45 and 50. If the PSA value is then below 0.5, a check-up is not necessary for eight years. "If you have values ​​above 1, you should check more closely."

However, the PSA value can also rise after a long bike ride, after sexual intercourse, with benign enlargement of the prostate or inflammation of the urinary bladder or prostate. If the value is above 3, prostate inflammation or urination disorders should be excluded and a biopsy should then be performed. If cancer shows up in the early stages, you can operate or actively monitor it, i.e. regularly determine the PSA value and take biopsies. As an alternative, the tumor can be irradiated.

Maurice-Stephan Michel, chief urologist at the University Clinic Mannheim, is against recommending the test to every man regardless of age. "You have to decide that individually," he says. "Because an increased value can result in other examinations or interventions that cause complications." These include, for example, impotence or incontinence.

Living with uncertainty

In some cases, however, prostate cancer grows so slowly that it does not cause any symptoms and a man does not die from it. Often it is enough to check closely whether the tumor continues to grow. But not all men can cope with the ever-present uncertainty as to whether the cancer is progressing or not. "The decision for or against the test is not easy," admits Michel. "You have to get comprehensive information and ultimately form your own opinion. One thing is certain: the PSA test can save lives." (Felicitas Witte, 10.10.2017)

What is PPE?

In 1970 Richard Ablin, a professor at the University of Arizona, found a protein that is produced in the prostate and released into the seminal fluid. He called it prostate-specific antigen, or PSA for short. It is used to make the ejaculate more fluid so that the sperm can move around in it.

Research showed that men with prostate cancer had a greatly increased PSA level. In 1980 researchers from Japan developed a blood test that can be used to determine the PSA level. The test was introduced across the board, and what one had hoped for happened: prostate cancer could be detected earlier, the men received treatment earlier and fewer died. The ERSPC study of 162,388 participants confirmed that the test reduced mortality from prostate cancer by 21 percent. (fewi)

For further reading:

Study: Beer increases the risk of prostate cancer, wine lowers it

New combination of active ingredients allows prostate cancer cells to die faster

New form of diagnosis of prostate cancer using MRI