Personalisierte Screening-Strategien des Prostatakarzinoms

Prostate-specific antigen (PSA)-based prostate cancer screening is controversial despite evidence of a reduction in cancer-specific mortality, primarily due to the low specificity of the PSA test. This non-systematic review provides an update on the current state of evidence analysis for prostate cancer screening. The current German early detection program, based on digital rectal examination (DRE), is neither specific nor sensitive enough. In the absence of a structured screening program, a PSA-based opportunistic screening is currently conducted in Germany, which is not recommended due to an unfavorable benefit-risk ratio. Since 2022, the European Commission has called for organized, risk-adjusted, PSA-based screening strategies that incorporate MRI imaging. MRI improves the diagnosis of clinically significant prostate cancer and reduces the detection of low-risk cancers. Prostate cancer early detection should be organized, personalized, and evidence based, with PSA level and complementary prostate MRI playing a central role.