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Prostate Cancer Screening

How is a prostate cancer screening carried out?

Prostate cancer screening is still one of the most disputed topics in urologic literature at present. Routine screening includes the palpation of the prostate and the measurement of PSA. The latter is performed after taking a blood sample. In case of an elevated PSA level other examinations, such as tests measuring special forms of PSA (free, and bound), may be necessary. There is growing effort to use other molecules in diagnostic screening tests (PCA3, genetic testing). The sensitivity of these, however, is not reliable enough yet to be used routinely. Imaging techniques (ultrasound, MR) in prostate screening may help additionally, among which multiparametric MR is the most reliable procedure currently.

When is prostate cancer screening recommended?

After age 40, it is recommended to see a urologist annually for a general screening. If any family member of the male patient was diagnosed with prostate cancer (especially on the father’s side), it is necessary to include PSA testing in the screening above age 45. In case of having certain gene mutations (e.g. BRCA2) from the age of 45 otherwise, from the age of 50, performing a PSA test is also recommended during the screening.

How is the examination performed?

The careful palpation of the prostate is performed through the rectum. The PSA level is determined from a blood sample in a laboratory. If suspicion of prostate cancer arises, the diagnosis can only be excluded or confirmed by taking a tissue sample for histologic examination (prostate biopsy). The most gentle and advanced way to carry out such biopsies is to employ MR-fusion transperineal biopsy (the so-called fusion biopsy) using artificial intelligence.