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PSA-Test zur Früherkennung des Prostatakarzinoms

Epidemiologischer Wissensstand zur Wirksamkeit

  • Früherkennung
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Prostatakrebs ist hierzulande seit einigen Jahren die häufigste Krebserkrankung bei Männern. Da über die Ätiologie wenig gesichertes Wissen vorliegt und daher kaum Möglichkeiten zur primären Prävention bestehen, konzentrieren sich die Anstrengungen auf die Suche nach wirksamen Verfahren zur sekundären Prävention. Hierbei gilt die Verwendung des PSA-Tests zur Früherkennung des Prostatakarzinoms als derzeit aussichtsreichstes Verfahren. Bevor ein neues Früherkennungsverfahren zur breiten Anwendung empfohlen oder in das gesetzliche Früherkennungsprogramm aufgenommen wird, muss jedoch seine Wirksamkeit in hierfür geeigneten wissenschaftlichen Untersuchungen nachgewiesen werden. Bis jetzt gibt es bereits eine ganze Reihe epidemiologischer Studien zur Effektivität des PSA-Screenings, doch konnte ein Wirksamkeitsnachweis bisher nicht erbracht werden. Zwei große randomisierte Studien in Europa und den USA lassen für die Jahre 2005–08 erste Ergebnisse erwarten. Da epidemiologische Arbeiten belegen, dass durch PSA-Screening eine nicht unerhebliche Überdiagnostik und Übertherapie eintritt, d. h. Schaden angerichtet werden kann, ist das Ergebnis der genannten randomisierten Studien vor weitergehenden Entscheidungen unbedingt abzuwarten. Bis dahin sollte von der Anwendung des PSA-Tests zur Prostatakrebsfrüherkennung unmissverständlich abgeraten werden. Da für den Test bereits ausgiebig Werbung betrieben wurde, kommt einer gründlichen ärztlichen Aufklärung von an dem Test interessierten Personen eine Schlüsselrolle zu.

Abstract

Since a couple of years, prostate cancer is the most frequent cancer site among males in Germany. Its etiology is largely unknown so that it is largely inaccessible for primary prevention. Efforts focus on determination of effective modes of secondary prevention. Among them, the application of the PSA test for early detection is considered the most promising. Prior to general recommendation or incorporation into the German Statutory Early Detection Programme, the efficacy and effectiveness of a new screening modality has to be proven in appropriately designed studies. By now, quite a number of epidemiological studies about PSA screening exist, but none of them succeeded to prove effectiveness. Two large randomized studies in Europe and the USA let expect first results by 2005–2008. Since epidemiological data indicate that PSA screening implies considerable overdiagnosis and overtreatment, i.e. harm to the screenees, the results of the randomized studies have to be available for final decision. In the time before, the application of the PSA-test for early detection of prostate cancer should clearly be discouraged. Since the test has already been extensively advertised for, an accurate medical advice for potential applicants is crucial.

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Authors and Affiliations

  1. Abt. Klinische Epidemiologie, Deutsches Krebsforschungszentrum, Heidelberg

    N. Becker

  2. Abt. Klinische Epidemiologie, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 , Heidelberg

    N. Becker

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Becker, N. PSA-Test zur Früherkennung des Prostatakarzinoms. Onkologe 10, 66–74 (2004). https://doi.org/10.1007/s00761-003-0617-8

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