Until now, experts in the USA had expressly spoken out against a widespread use of the PSA test for the early detection of prostate cancer. Since then the US Preventive Services Task Force (USPSTF) has revised their negative judgment about its benefits. The 180-degree turnaround is due to new study results showing a clear decrease in mortality and metastasis in PSA-tested men, as well as a reassessment of the American PSA screening study (PLCO).

Experts in the USA criticized the PSA test mainly as a result of an American study in-volving more than 75,000 patients published in the New England Journal of Medicine in 2012. There was no difference between men who had testing for the prostate spe-cific antigen (PSA) in the blood and those who did not. However, a recent analysis of the study1 revealed major methodological shortcomings. In retrospect, for example, it was found that 90 percent of the allegedly untest-ed men had secretly tested themselves and, if necessary, even had treatment.

Survival benefit and lower risk of metastasis

In addition, an updated evaluation of the European study (ERSPC study) published for the first time in 2009 motivated the US expert panel to reassess the significance of PSA testing in the early detection of prostate cancer. Thereafter, regular screening of the PSA level leads to fewer metastases and reduces mortality by prostate cancer. The study shows that prostate cancer mortality can be reduced by around 20 percent in 13 years through PSA screening.

“This is clear evidence of the benefits of PSA testing in prostate cancer screening," says Dr. Stephan Neubauer from the West German Prostate Center in Cologne. However, according to the urologist, the correct handling of the test results is essential for the further procedure. It often happens that PSA values are misinterpreted and action is taken prematurely. For example, benign prostate enlargement or inflammation can lead to increased but harmless PSA levels. “It is always essential to have a professional-founded evaluation of a man's overall findings and not an isolat-ed evaluation of the PSA”, summarizes Dr. Neubauer.

1 Shoag JE1, Mittal S1, Hu JC2.: Reevaluating PSA Testing Rates in the PLCO Trial. N Engl J Med. 2016 May 5;374(18):1795-6. doi: 10.1056/NEJMc1515131.

2Schröder FH et al.: Screening and prostate-cancer mortality in a randomized Euro-pean study. N Engl J Med. 2009 Mar 26;360(13):1320-8. Epub 2009 Mar 18.

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