New Guidelines Eliminate Digital Rectal Examination for Prostate Cancer Screening

The prostate cancer landscape in Germany has undergone significant changes as recent guidelines recommend a shift in early detection strategies. Prostate cancer remains the most common malignant tumor among men in Germany, often presenting without noticeable symptoms. The updated S3 guidelines, released by the German Urological Society (DGU), introduce a novel approach to screening and risk assessment for localized prostate cancer.

The revised guidelines emphasize that early detection does not equate to prevention of prostate cancer. Instead, the focus is on identifying aggressive forms of the disease early enough to prevent metastasis and avoid the need for extensive treatments, such as hormone therapy. A key change is the recommendation to discontinue the use of digital rectal examinations (DRE) as a standard screening method.

Men aged 45 and older who desire screening after proper counseling are encouraged to undergo a blood test for prostate-specific antigen (PSA). This test serves as a basis for assessing risk levels associated with prostate cancer. The guidelines propose a risk-adjusted follow-up strategy based on the PSA levels: for those with a PSA level of 1.5 ng/ml or lower, screenings should occur every five years; for levels between 1.5 and 2.99 ng/ml, every two years; and for levels at or above 3 ng/ml, further diagnostics should be initiated within three months.

If elevated PSA levels persist, a referral to a urologist is advised, along with a potential MRI of the prostate. Importantly, if the MRI results are normal, the guidelines recommend against performing a biopsy, thereby reducing the likelihood of detecting non-threatening tumors that do not necessitate treatment.

These new recommendations are seen as a pivotal advancement towards establishing an organized, risk-adjusted PSA-based prostate cancer screening program that would be covered by statutory health insurance.

The debate surrounding PSA screening continues, with the guidelines outlining both its advantages and disadvantages. Benefits include a potential reduction in prostate cancer mortality and the frequency of advanced disease diagnoses. However, concerns remain regarding psychological distress associated with early detection of non-life-threatening tumors, the risk of overdiagnosis (with approximately 14 men needing to be diagnosed to prevent one death), and the possibility of overtreatment.

Additionally, specific recommendations exist for men with a family history or genetic predispositions to prostate cancer, ensuring tailored screening approaches for those at heightened risk.