Private practice for urology

Prostate cancer screening

> What is this? <

The best-known word for early detection is prevention. In professional circles, however, the term screening is used. In this text, I will also use the term "screening", because I find "precaution" misleading. If you take precautions, you can prevent adverse events. But that is exactly what screening cannot do. It cannot prevent cancer from developing, although many believe it can. The examination is an inventory with the available means. The examination methods have their limits, so it is never possible to rule out with complete certainty that something very small is not developing or that something will not develop in the future.


> Was ist das? <

Das bekannteste Wort für Früherkennung ist Vorsorge. In Fachkreisen benutzt man hingegen den Begriff Screening. Ich werde in diesem Text ebenfalls eher von Screening reden, da ich Vorsorge irreführend finde. Wer vorsorgt, kann unerwünschte Ereignisse verhindern. Aber genau das kann die Vorsorgeuntersuchung nicht. Sie kann nicht verhindern, dass Krebs entsteht, obwohl das viele glauben. Die Untersuchung ist eine Bestandsaufnahme mit den zur Verfügung stehenden Mitteln. Die Untersuchungsmethoden haben ihre Grenzen und so lässt sich nie mit völliger Sicherheit ausschließen, dass nicht doch etwas ganz Kleines gerade im Entstehen ist oder ob nicht in Zukunft etwas entstehen wird.

So why do we need this investigation?

It serves the purpose of risk management. A regular inventory offers the chance to detect and cure cancer at an early stage. How nice it would be if I could close this topic by saying: have your prostate palpated and the prostate specific antigen (PSA) tested in your blood. Done.

Prostate Specific Antigen (PSA) is a protein naturally produced in the prostate gland that plays a role in liquefying sperm and is therefore important for reproduction. A small amount can also always be detected in the blood. In the case of cancer or other triggers, this value can increase.

Early detection program

> Not all cancer is the same <

As is often the case in life, however, it is not that simple. There are opportunities, but also risks to consider. Prostate cancer detected in the early stages has a very good chance of being cured. If you have one or more first-degree male relatives, you should be screened from the age of 45. For men with a known BRCA2 mutation (you know, the "breast cancer gene" in women, Angelina Jolie, mastectomy), this applies from the age of 40. If you suffer from an increased urge to urinate, the urinary stream is weakened, you have to go to the toilet more often at night, etc., you should have this clarified. In most cases, these symptoms are due to a benign disease, but in rare cases, prostate cancer may be the cause.

Screening, however, is not about detecting a cancer early, but about early detection, and there is a difference. Early detection is screening for people who do not belong to any particular risk group, who have no symptoms, who feel healthy and, most importantly, who are at the right age for screening. While early detection is initiated by the patient or the patient's physician, screening usually originates from health authorities and involves the systematic screening of a defined population. As early as 1968, the World Health Organization (WHO) defined standards for the implementation of such programs, which are still valid today in slightly modified form. The debate about PSA and its affordability by statutory health insurance is fed by the mentioned conflict.


> Krebs ist nicht gleich Krebs <

Es gilt Chancen, aber auch Risiken zu beachten. Ein im Anfangsstadium erkannter Prostatakrebs hat sehr gute Heilungschancen. Wenn Sie einen oder mehrere männliche Verwandte ersten Grades haben, sollten Sie sich ab dem 40. bis 45. Lebensjahr untersuchen lassen. Wenn Sie unter vermehrtem Harndrang leiden, der Harnstrahl abgeschwächt ist, Sie nachts häufiger auf die Toilette müssen etc., sollten Sie das abklären lassen. Meist verbirgt sich hinter diesen Symptomen eine gutartige Erkrankung, in seltenen Fällen kann aber auch ein Prostatakrebs die Ursache sein.

Beim Screening geht es aber nicht um das frühe Erkennen einer Krebserkrankung, sondern um Früherkennung und das ist ein Unterschied. Früherkennung ist eine Reihenuntersuchung für Menschen, die keiner besonderen Risikogruppe angehören, die keine Symptome haben, sich gesund fühlen und vor allem im richtigen Alter für Früherkennungsuntersuchungen sind. Während frühes Erkennen vom Patienten oder dessen Arzt initiiert wird, geht Früherkennung für gewöhnlich von den Gesundheitsbehörden aus und umfasst die systematische Untersuchung einer definierten Population. Bereits 1968 hat die Weltgesundheits­organisation (WHO) Standards für die Einführung solcher Programme definiert, die bis heute in leicht abgeänderter Form gültig sind. Aus dem Widerstreit zwischen Früherkennung und frühem Erkennen speist sich die Diskussion um PSA und dessen Bezahlbarkeit durch die gesetzliche Krankenversicherung.

The following criteria must be met for an early detection program (screening program):

  1. the disease must represent a significant health problem         
  2. there must be a treatment option for the disease      
  3. the infrastructure for diagnosis and treatment must be available        
  4. the disease must have a latent (early) phase
  5. there must be an appropriate test or method of investigation              
  6. this method of investigation must be acceptable to those being investigated
  7. there must be an adequate understanding of the natural history of the disease          
  8. there must be agreement in advance as to who will be treated           
  9. the cost of the program must be proportionate to the overall expenditure of the health care system
  10. early detection is not a one-time event, but a continuous process   
"We take the functions of the body for granted. The trouble starts when seemingly mundane functions suddenly stop working."

Dr. Dr. Stefan Buntrock

The WHO specifications in detail

Most items can be checked off immediately. Prostate cancer is a significant health problem. It is the most common cancer in older men in the Western world, and when men die of cancer, the second most common cause is prostate cancer. Treatment options in the early stages are very good with excellent chances of cure. In Germany, we have one of the best healthcare systems in the world, with diagnosis and treatment readily available. Palpation and PSA testing are not only suitable examination methods, but are also acceptable to those being examined, as they are not very time-consuming.

Prostate cancer has a latent early stage

Of course, there are other diagnostic options. However, all of these must remain within affordable limits (point 9). MRI and other expensive examinations would go beyond the financial scope. Even nationwide PSA screening financed by the health insurance system could easily cost the systems an additional half billion euros a year. As I said, annually, because early detection is a continuous process that involves testing at regular intervals.

Prostate cancer has a latent early phase, insofar a WHO criterion would be fulfilled. However, this gives rise to special problems, which I will discuss below. Latent early phase or latency phase means that although individual cancer cells can be detected at this stage, they remain in a kind of hibernation. Normally, cancer cells behave in such a way that they multiply unchecked, seek a connection to lymphatic or blood vessels and form daughter tumors, so-called metastases. In the case of prostate cancer, this is referred to as a clinically relevant disease. This is not the case in the latency phase. We know that there is a latency phase from autopsy studies. In this type of investigation, the prostate has been examined in deceased persons of all ages and causes of death (except prostate cancer).

Thus, cancer cells were found in 5% of cases even in those under 30 years of age. In men aged 80 and older, more than half were affected (1). What causes these changes is still largely unknown.


Privatpraxis für Urologie & Sexualmedizin

Dr. med. Dr. phil. Stefan Buntrock 

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In der Worth 16
37077 Göttingen


  • modernstes Ultraschallgerät der Firma BK Medical mit Farbduplex und Elastographie
  • ESWT-Gerät Dornier Aries II der neuesten Generation für die Behandlung von Potenzstörungen
  • Neues Video-Zystoskopiegerät der Firma Olympus für die Blasenspiegelung
  • Uroflow-Messgerät
  • eigenes urologisches Labor
  • die Praxisräume sind barrierefrei zugänglich, rollstuhlgerecht und verfügen über eine Behindertentoilette