April 21, 2025, 12:03 pm | Read time: 7 minutes

Although most men die with prostate cancer rather than from it, this type of cancer can be easily cured if it is detected early. Unfortunately, screening by a urologist often only consists of men around the age of 50 having their stomachs pressed once—this can cover a lot, but not everything, says oncologist Dr. Rainer Lipp. Below, we reveal the procedure he recommends for men from midlife onwards.

The Examining Doctor Receives 17.85 Euros for a Palpation Examination

In Germany, men aged 45 and over with statutory health insurance are entitled to an annual prostate cancer screening examination. This service, covered by statutory health insurance, includes a digital rectal exam (DRE) where the doctor checks the prostate for hardening or abnormalities using a finger. In addition to this palpation of the prostate from the rectum, lymph nodes in the groin should also be palpated.

In practice, according to Dr. Rainer Lipp, these early detection services are currently reimbursed by the statutory health insurance companies at 17.85 euros. For the oncology specialist, this sum appears to be only partially economical in relation to the work performed. One might wonder: How thorough is the examination for this fee? Understandably, Rainer Lipp does not want to attack any examining doctors. However, no one can rule out the possibility that one or two palpation examinations will be limited to a brief press on the abdomen. For the average man relying on these early detection exams, the quality of the examination may not be readily apparent.

“Palpation of the Prostate Is Not Really Suitable for Providing Sufficient Certainty in the Early Detection of Cancer”

Equally, if not more important, is the question: Is the rectal examination the most suitable method for early detection of prostate cancer? There is increasing doubt about this among experts, says Lipp. He goes one step further: “Prostate palpation is not really suitable for providing sufficient certainty in the early detection of cancer.” This is particularly true for younger men between the ages of 45 and 55.

A 2022 study led by the German Cancer Research Center revealed that only 0.9 percent of digital rectal exams yielded an abnormal finding. However, prostate cancer could only be detected by biopsy in 5 percent of these abnormal findings.²

Better Than Palpation: the PSA Test

In contrast, another method for the early detection of prostate cancer performed much better than the palpation test: the so-called PSA test. In the above-mentioned study, this test had a detection rate for malignant tumors that was four times higher than the palpation test. Another alarming result of the study: of the prostate carcinomas detected by a PSA test, 86 percent had inconspicuous palpation findings.

The PSA test measures the level of prostate-specific antigen in the blood. This protein, which is only produced in the prostate, can be used to estimate the risk of malignant changes even at a very early stage. The higher the value, the more likely it is that a tumor is present. Dr. Lipp thinks a lot of it: “It has to be said that these PSA tests are quite sensitive. They give good indications and can be used to fish out a lot of previously undetected prostate carcinomas.”

A common concern: Unfortunately, PSA tests are not yet covered by statutory health insurance for early detection purposes. Despite an explicit recommendation in current guidelines. Individuals must cover the costs of 25 to 35 euros themselves, unless there is a specific suspicion of prostate cancer, according to Lipp.

Downside: Risk of Overdiagnosis

But PSA tests also have a downside. According to Lipp, these need to be discussed more. “There are a number of gray areas where the PSA value is slightly elevated and you sometimes don’t know exactly what the best next step is.”

Studies have shown that slightly elevated PSA values can result in overdiagnosis and, consequently, overtreatment. As a result, older men in particular are treated more than is sometimes necessary, explains Lipp. This could not reduce the death rates caused by prostate cancer.

An analysis of data from the USA confirms this. It showed that men with a limited life expectancy often received aggressive therapies such as radiation, even though their tumor would probably not have caused any problems during their lifetime. This finding is one of the reasons the Joint Federal Committee has not yet incorporated PSA value measurement into the early detection guidelines, Lipp explains.

Most Men Die with and Not from Prostate Cancer

It is, therefore, important to carefully consider and discuss with the doctor whether a PSA test would be helpful for him in his current life situation. “Prostate carcinomas are slow-growing tumors and are predominantly a problem in older men,” says Lipp. While many men who die from other causes are found to have undiagnosed prostate cancer, it is also true that 20 to 25 percent of patients with prostate cancer succumb to the disease.

This means that the examination could also detect cases of cancer that would never have become life-threatening, resulting in unnecessary treatment with possible side effects. The majority of men die with prostate cancer, not because of it.

“Surgery or Radiotherapy Can Cause Incontinence and Erectile Dysfunction”

With this knowledge, aggressive treatments should be considered, argues the oncologist. “Surgery and radiotherapy can certainly have noticeable consequences that restrict quality of life, including incontinence and erectile dysfunction. This definitely needs to be discussed before such treatments,” argues Lipp.

The German Cancer Society also argues the same. The benefits of early detection, specifically preventing deaths from prostate cancer, must be carefully weighed against the disadvantages of potential overdiagnosis or overtreatment.³

Nevertheless, the oncology specialist urgently cautions against dismissing prostate cancer as a benign age-related cancer: “The patient and the possible treatment options should always be viewed holistically. In recent years in particular, many new non-surgical approaches have emerged.”

Every Man Over 50 Should Ask Himself These 2 Questions

Beyond the value of screenings, every man over 50 should consider the following questions: Do I have difficulty urinating? Am I unable to urinate despite a strong urge to urinate and a full bladder? “If you have to answer ‘yes’ to one or both of these questions, please go to a urologist and have it checked out,” advises Lipp. “As part of this clarification, a self-paid PSA test is certainly a good investment in your own health.”

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Early Prostate Cancer Detection: What Should Men Do Now, When, and How Often? What the Oncologist Advises

• Men aged 45 and older should undergo an annual check-up with a urologist, and even earlier if they have a family history: men whose fathers or brothers have or had prostate cancer have a two-fold increased risk of also developing the disease. An upper age limit for this test is not recommended.
• A PSA test is advisable starting at age 45 for those with a life expectancy of at least ten years.
• Follow-up examinations should be carried out in accordance with guidelines based on age and results.
  • For men aged 45 and over and with a life expectancy of ten years or more
    • PSA < 1 ng/ml: interval every four years
    • – PSA 1-2 ng/ml: interval every two years
    • – PSA > 2 ng/ml: interval every year
  • For men over 70 with a PSA level below 1 ng/ml, additional PSA-based screening is not advised.