[Problems, objective, and substance of early detection of prostate cancer]

The current S3 guideline for early detection of prostate cancer initiates a change to the paradigm in early detection from the detection of all prostate cancers to the identification of aggressive prostate cancers. Early detection is performed annually and starts at the age of 40 years; it should be terminated at a life expectancy of less then 10 years. The choice of the frequency of early detection should be risk adapted. The digital rectal examination is supplemented by determination of PSA. Previous to the first PSA test the patient has to be informed concerning possible consequences such as biopsy recommendation and treatment options. A threshold of 4 ng/ml is defined as an indication for prostate biopsy for the first administration. In the following early detections the PSA velocity should be considered. Today imaging methods do not play a major role in early detection of prostate cancer. Early detection identifies many latent prostate cancers and patients may receive overtreatment. The recent S3 guideline for early detection is discussed against this background on the basis of the recent literature.