When should men go for prostate cancer screening and what happens during screening?

All people over 45 have a legal right to annual cancer screening by a urologist. Currently, however, statutory health insurers will only pay for digital rectal examination of the prostate (examining the prostate using a finger inserted into the rectum) and examination of the external genitalia. This primarily involves the doctor feeling the prostate to check for any suspicious lumps.

On its own, however, this is not sufficient to allow early detection of all prostate cancers, as many prostate cancers are not palpable or only become palpable at a later stage. Small cancers in the middle of the prostate in particular simply cannot be felt using this method. Conversely, where a cancer is palpable, it will often already be very advanced, so that it is already too late for early detection and the chances of being cured are significantly lower.

Measuring the level of PSA (prostate-specific antigen) in the blood is therefore essential for early detection of prostate cancer. If a raised PSA level is identified, it must always be considered as a potential sign of cancer and must always be investigated. A raised PSA level does not automatically mean that a patient has prostate cancer, however.
In Germany, if you would like the doctor to check your PSA level you will have to pay part of the cost for this test (approx. 20 euros).
In some cases, it may also be necessary to carry out a transrectal ultrasound examination (an ultrasound examination of the prostate using a probe inserted into the rectum) as a precautionary measure, particularly where the PSA level has been found to be raised. Statutory health insurers do not currently pay for this examination either.

On the following pages we aim to outline current options for early detection of prostate cancer using specific laboratory tests and imaging procedures.