Around 57,000 men in Germany develop prostate cancer within a year, making it the most common tumor disease among them. Almost 14,000 die every year from the consequences. The so-called PSA test promises to detect the disease early and thus give men the chance to survive the cancer through timely therapy. In some cases this actually works.
So does it make sense to offer the tests to all men from a certain age and not only to those who are already suspected of cancer or who are at increased risk?
No, judges the Institute for Quality and Efficiency in Health Care (IQWiG) in a current preliminary report. Because the test causes so much damage overall, according to the IQWiG, that the statutory health insurance companies should not bear the costs.
Studies evaluated by the IQWiG indicate that the harm is greater than the benefit. Anyone who thinks that a cancer test can only have positive consequences and not negative ones is wrong.
In a total of eleven studies with more than 400,000 participants, who were either regularly invited to PSA tests or not, the following has emerged.
The advantages of PSA screening:
- Out of 1,000 men who are invited for cancer screening, around three are saved from metastatic cancer over the course of twelve years.
- Over a period of 16 years, three out of every 1,000 men die of prostate cancer. However, the so-called overall mortality rate does not decrease. On average, patients are 72 years old when they develop prostate cancer. Therefore, many of those affected do not die from prostate cancer, but from something else.
The disadvantages of PSA screening:
- More than 200 out of 1,000 participants in early detection are suspected of having cancer due to an increased PSA level, but this is not confirmed afterwards. The amount of prostate-specific antigen (PSA) in the blood is not only increased in prostate cancer. These findings are stressful for men; the removal of tissue (biopsy) carried out for clarification can also lead to infections.
- About 35 to 60 out of 1,000 men are diagnosed with prostate cancer, although cancer would never have been a problem for them; one speaks of overdiagnoses. The following - actually unnecessary - cancer therapy can do permanent damage to these men.
"Screening measures can cause significant damage," says IQWiG director Jürgen Windeler. "PSA screening, in particular, results in a significant number of overdiagnoses, which are stressful in themselves, but above all result in overtreatments and can ultimately lead to serious and long-lasting complications such as incontinence and impotence."
The conclusion of the institute is that screening would therefore harm significantly more men than it would benefit.
Just recently, the German Society for General Medicine and Family Medicine issued a similar recommendation in a new guideline: Men should not be actively offered early detection using the PSA value. If patients ask themselves, they should be informed about advantages and disadvantages. The goal is to protect men from overdiagnosis and over therapy.
While the health insurance companies do not cover the cost of the PSA test, they pay for another prostate cancer screening: a prostate scan by a doctor. The IQWiG, which currently only had the task of testing the PSA test, did not investigate the relationship between benefit and harm in this investigation. However, there is no reason to assume that it would do better in an assessment, writes the institute.