Early detection of prostate cancer
Because the chances of recovery are great for prostate cancer at an early stage, men are to be carried out even at 40 regularly a digital rectal examination (DRE) and a determination of the PSA value.
Goal of early detection is to discover a possible prostate cancer at a stage where it is still locally, that is confined to the prostate. Because only so long is the possibility of a curative (healing) therapy such as surgery (see radical prostatectomy ) or radiation (see radiation therapy ).
However, only rarely the tumor at an early stage causes symptoms such as urinary symptoms (see symptoms ) because he usually far arises from the urethra in the outer regions of the prostate (s emergence and forms ). Therefore, the digital rectal examination (used to earlyDRE , digital rectal examination) and the measurement of the PSA value in the blood (see PSA) used. The collection of anamnesis (medical history) may also cases of prostate cancer in the family and therefore an increased risk uncover (see Causes ).
The screening (the government controlled screening) of all men by PSA test is still not recommended, so that health insurance cover the cost of the test for the early detection does not take over (but probably for the follow-up of existing tumor). Because there is currently no hard evidence that the benefits of screening for all men is greater than a potential disadvantage: the risk of dying of prostate cancer, although slightly lower. Return, but have (too) many men a biopsy and an afflicted with any serious side effects undergo treatment (see also discussion about the PSA screening despite positive results ).
In contrast, in Germany there is a supported by the health insurance individual screening program, which is unfortunately rarely used by men than by women (see also self-test ). Then, each legally assured man from the 45th Age entitled to an annual screening for early detection of prostate cancer with history and physical examination, including DRE.
According to the latest medical guideline from 2009 to men who want a screening test "on their own responsibility", in addition to DRE, a PSA test is recommended. A sole DRU is not enough, because a tumor can only grope at a certain location and only above a certain size (see alsoDigital rectal examination ). Likewise, imaging and PSA test strips are not suitable because of their lack of precision. In addition, test strips (the important doubling time, for example, lack the ability to determine the course of PSA levels PSA-DT , to rapid tests also see PSA test ).
The PSA test for early diagnosis should be offered to men over 40 years. On one hand, as is an early PSA level before observed more closely with the aid of the course and the need for treatment to be better assessed at a later possible increase. On the other hand, also more not requiring treatment tumors would perhaps have been found. The test should also only men are offered with a life expectancy of more than 10 years (depending on age and comorbidities) because prostate cancer usually so slow growing that with a shorter life expectancy no survival advantage is to be expected from a curative therapy.
Before deciding to early detection examination, the physician should inform the patient exactly: About the significance of positive and negative results (see also PSA test ), which afterwards may be necessary biopsy (see also prostate biopsy ) as well as the various treatment options (including active surveillance ) and their risks.
There is a raised PSA level, is first, to examine in particular before a biopsy, whether the increase in causes a problem going back (see Influences on the PSA serum levels , also eg incorrect storage of the sample). In case of doubt, the value should be checked with the elimination of interferences. Otherwise, a check is generally after 2 years at a value of less than 2 ng / ml and after 1 year at a higher value is recommended (the limit may be slightly lower depending on the test method).
A prostate biopsy is recommended if at least one of the following three criteria is met:
- Suspicious findings in the digital rectal examination (see also Digital rectal examination )
- Controlled PSA level of 4 ng / ml at the first examination (the limit may be slightly lower depending on the test method)
- Abnormal rise in the PSA value (not defined in the guideline, such as PSA velocity increase from 0.75 ng / ml / year)
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