Early detection of cancer can save lives. That is indisputable. But which method is suitable? Who should be examined and how often? And who bears the costs of the examination? These and other questions are always the subject of heated debate. One example is the early detection of prostate cancer. With around 80,000 new cases, prostate cancer is currently the most common type of cancer in men. Every year, the disease claims around 12,000 lives. However, if the tumor is detected at an early stage, the prospects of recovery are very good: as long as the cancer is confined to the prostate, the chance of recovery is 85 to 100 percent. But it is precisely these small, often deeper-lying tumors that are frequently overlooked in the early detection methods commonly used in Germany.
Here in Germany, the only legally guaranteed cancer screening method is the palpation of the prostate, and the costs are borne by the health insurance company. The situation is different in the USA. There, early detection has been supplemented by a blood test. With success: according to initial estimates, the number of deaths from prostate cancer fell by around 25 percent last year alone.
Prostate Specific Antigen
Prostate-specific antigen (PSA) is a protein that is released into the blood in increased amounts in various prostate diseases. However, not all PSA is the same. The so-called total PSA (tPSA) is usually measured. It is composed of the bound or complexed PSA (cPSA) and a free part (fPSA). Free PSA is primarily secreted in increased amounts in benign prostate diseases. In contrast, cPSA is increased primarily in prostate carcinomas.
Blood test for early detection
Recently, a blood test has also become available that detects only cPSA. It reliably detects even the smallest concentrations. Elevated values indicate carcinoma with greater certainty than with tPSA – even if the palpation examination revealed no indications. In this case, the urologist usually recommends a tissue examination for final clarification. The number of false-positive results is significantly lower with cPSA than with tPSA. This provides a method for the early detection of prostate cancer that is more sensitive and more accurate than previously used methods. This has been confirmed in several clinical studies.
Screening recommendations
The German Society of Urology DGU recommends annual cancer screening for men over the age of 50. If there is a family history of cancer, early detection should begin at age 45, they say. Anyone in Germany who wishes to have the cPSA value measured can obtain details from their urologist. The cost is around 20 euros. However, if there is a positive palpation result, then the insurance companies will cover the cost of the blood test for PSA.
