[Intelligent early prostate cancer detection in 2021: more benefit than harm]

Area of Science:

• Oncology
• Urology
• Public Health

Background:

• Prostate cancer is the most common cancer in men in Germany and Europe.
• Prostate-specific antigen (PSA) testing is a key tool for early prostate cancer detection.
• Screening trials show PSA testing reduces advanced disease and cancer-specific mortality.

Purpose of the Study:

• To address the overdiagnosis and overtreatment of insignificant prostate cancers due to PSA testing.
• To advocate for an individualized, risk-tailored modern strategy for prostate cancer detection.
• To highlight the importance of baseline PSA testing within this modern strategy.

Main Methods:

• Analysis of results from large-scale prostate cancer screening trials.
• Evaluation of the role of baseline PSA testing in prostate cancer detection.
• Consideration of validated instruments to accompany PSA testing.

Main Results:

• PSA testing effectively reduces the incidence of locally advanced and metastatic prostate cancer.
• Early diagnosis via PSA testing can lead to overdiagnosis and overtreatment of indolent cancers.
• Baseline PSA is crucial, but its coverage by German health insurance is currently declined.

Conclusions:

• A shift towards individualized, risk-tailored strategies is necessary for prostate cancer management.
• Validated instruments should complement baseline PSA testing to improve the detection of clinically significant prostate cancer.
• Optimizing prostate cancer screening requires a comprehensive approach beyond simple PSA measurement.