Video: detecting prostate cancer early – what the PSA test can do and where its limits lie

Prostate cancer is one of the most common cancers in men. In a short explainer video from the US Mayo Clinic dated 7 October, radiation oncologist Dr Albert Attia describes how screening works: it can start with a blood test for prostate-specific antigen (PSA), a protein made by the prostate. An elevated level may mean further evaluation is needed. "Screening is important because the earlier you catch prostate cancer, the higher the likelihood of cure," Attia says. Depending on the findings, treatment options include surgery, hormone therapy, radiation or a combination.

Attia cites a US recommendation to start screening at 50, adding that some data favour starting at 45, especially with a family history. In Germany, statutory health insurers pay for an annual digital rectal examination for men aged 45 and over. PSA screening, however, is a self-pay service; insurers cover it only if cancer is suspected, there is a family history or during cancer treatment. According to the consumer organisation Verbraucherzentrale, the revised S3 medical guideline (preliminary version of March 2025) no longer considers the rectal examination a suitable screening method and instead provides for a PSA test for men from 45 with a life expectancy of at least ten years after detailed counselling, followed by an MRI before any biopsy if the result is abnormal. Family doctors' association DEGAM takes a more critical view of the test.

Benefits and risks are finely balanced: according to Verbraucherzentrale, studies show the PSA test saves 1 to 2 of every 1,000 men tested from dying of prostate cancer, while about 30 receive an overdiagnosis and possibly unnecessary treatment. Since October 2025, Germany's Federal Joint Committee (G-BA) has been reviewing a stepped, risk-adapted screening programme using PSA tests and MRI; a result is expected by October 2027 at the latest. Around 60,000 men in Germany are diagnosed each year, according to Verbraucherzentrale. Whether and when testing makes sense is best discussed with a GP or urologist.