Albers Peter, Franiel Tobias, Kötter Thomas, Kristiansen Glen, Herrmann Ken, Wiegel Thomas
Department of Urology, Heinrich-Heine University, Medical Faculty, Düsseldorf, Germany, Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Jena, Germany; Institute of Family Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; Institute of Pathology of the University Hospital Bonn, Bonn, Germany; German Cancer Consortium, Department of Nuclear Medicine, University Hospital Essen; Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
Dtsch Arztebl Int. 2025 Jul 5;122(15):420-426. doi: 10.3238/arztebl.m2025.0099.
Approximately 75 000 men receive a diagnosis of prostate cancer in Germany each year. New data on the early detection, diagnostic evaluation, and treatment of prostate cancer provide the basis for a paradigm shift in the management of locally confined prostate cancer.
This narrative review is based on the systematic literature search that was carried out for the 2025 update of the German clinical practice guideline on prostate cancer.
Risk-adapted early detection is now recommended. This involves the measurement of a baseline PSA value at age 45 whose magnitude determines the interval of follow-up testing: once every 5 years for baseline values below 1.5 ng/mL, and once every two years for baseline values between 1.5 and 3 ng/mL. Patients with PSA levels above 3 ng/mL should undergo a repeat PSA test and, if these levels are confirmed, receive a urological risk assessment including prostatic volume, family history, and past medical history. High risk patients should undergo magnetic resonance imaging (MRI) and, if necessary, prostate biopsy. This new PSA-MRI algorithm increases accuracy in detecting clinically significant prostate cancers, enabling the previously recommended annual testing and digital rectal examination to be avoided. Another novelty is that the indication for an active surveillance strategy for men with low-risk prostate cancer has been expanded to ISUP grade group 1 and 2 cancers with favorable risk.
The need for high-quality diagnostic testing, including MRI, with broad geographic coverage will be a major challenge to the health care system, especially with regard to accessibility. Patients can be expected to benefit greatly from the new PSA-MRI algorithm, as it eliminates unnecessary diagnostic testing and treatment while enabling necessary treatment to be initiated earlier and therefore with fewer side effects.
在德国，每年约有75000名男性被诊断出患有前列腺癌。关于前列腺癌早期检测、诊断评估和治疗的新数据为局限性前列腺癌管理模式的转变提供了依据。
本叙述性综述基于为德国前列腺癌临床实践指南2025年更新而进行的系统文献检索。
现推荐进行风险适应性早期检测。这包括在45岁时测量基线PSA值，其数值决定后续检测的间隔时间：基线值低于1.5 ng/mL时每5年检测一次，基线值在1.5至3 ng/mL之间时每两年检测一次。PSA水平高于3 ng/mL的患者应进行重复PSA检测，如果这些水平得到确认，则应接受包括前列腺体积、家族史和既往病史在内的泌尿外科风险评估。高危患者应进行磁共振成像（MRI）检查，必要时进行前列腺活检。这种新的PSA-MRI算法提高了检测临床显著性前列腺癌的准确性，从而避免了之前推荐的年度检测和直肠指检。另一个新变化是，低风险前列腺癌男性积极监测策略的适应证已扩大到具有良好风险的ISUP分级1组和2组癌症。
高质量诊断检测（包括MRI）的广泛地理覆盖需求将给医疗保健系统带来重大挑战，尤其是在可及性方面。预计患者将从新的PSA-MRI算法中大大受益，因为它消除了不必要的诊断检测和治疗，同时使必要的治疗能够更早开始，从而减少副作用。
