When it comes to men’s health, the term “PSA test” often comes up. But what exactly is it and why is it important? The PSA test measures the PSA level in the blood – a protein produced by the prostate. In Germany, it is an integral part of screening and diagnostics, especially for older men.

What is the PSA test?

PSA stands for “prostate-specific antigen”. This is a protein that the prostate – a small gland under the bladder that only men have – produces. It helps to keep the seminal fluid fluid. The PSA test involves taking a blood sample, usually from the vein in the arm, and examining how much PSA is floating in the blood in the laboratory. The value is given in nanograms per milliliter (ng/ml). The test itself is simple: a small prick and the sample is on its way to the laboratory.

Why is the PSA test carried out?

The PSA test has two main tasks:

• Early detection of prostate cancer: If the PSA level rises, this may be an indication of prostate cancer. The idea is to find cancer early before it causes problems.
  
• Monitoring: For men who already have or have had prostate cancer, the test helps to monitor the progress – for example after surgery or radiotherapy.

But not every elevated value means cancer. Benign changes such as an enlarged prostate (benign prostatic hyperplasia) or inflammation (prostatitis) can also drive up the PSA value.

What do the values say?

PSA values vary according to age because the prostate grows over time. In Germany, there are reference values that doctors use:

• Below 4 ng/ml: Mostly normal, but there are exceptions.
  
• 4-10 ng/ml: gray area – it is worth taking a closer look here.
  
• Above 10 ng/ml: Suspicion of something more serious, often followed by further testing.

Important: There is no fixed limit above which “cancer” is certain. A value of 3 in a 50-year-old can be more conspicuous than 5 in an 80-year-old. The doctor also looks at how the value changes over time – a rapid increase is more worrying than a stable value.

How does the test work in Germany?

In Germany, the PSA test is not a statutory preventive service (as of April 7, 2025) that is automatically covered by health insurance. Since 2019, men aged 45 and over have been able to have a prostate palpation test (digital rectal examination) once a year as a health insurance benefit, but the PSA test is an extra. Many urologists offer it anyway, often as a so-called IGeL service (individual health service). This means that patients pay for it themselves – around 20 to 30 euros, depending on the practice. However, if cancer is suspected (e.g. through a palpation test), the test is usually covered by the health insurance fund.

Why is the PSA test important?

Prostate cancer is the most common type of cancer in men in Germany – around one in six men will develop it in the course of their lives. The risk increases particularly from the age of 50, and the earlier the cancer is detected, the better the chances of recovery. The PSA test can provide a warning before symptoms such as pain or problems urinating occur. This gives doctors the chance to act in good time – either with further tests such as a biopsy or with treatment straight away.

What are the advantages and disadvantages?

The PSA test has its strengths, but also its weaknesses:

• Advantages: It is simple, fast and can save lives by detecting cancer early. Men with a family risk (father or brother with prostate cancer) benefit in particular.
  
• Disadvantages: It is not perfect. A high value can also have harmless causes, leading to unnecessary worries or examinations. Conversely, a normal value cannot rule out cancer. Some critics say that the test too often “over-treates” men whose cancer would not have become dangerous.

This is why a lot of emphasis is placed on education in Germany. Urologists discuss with patients whether the test makes sense instead of simply “waving it through”.

What happens if a value is abnormal?

A high PSA value is not a diagnosis, but an indication. The doctor will then often perform an ultrasound examination or a tissue sample (biopsy) to be sure. Sometimes they also wait and check the value again after a few weeks – for example, if an inflammation could be the cause.

Conclusion

The PSA test is an important tool in Germany for keeping an eye on the prostate. It helps to detect prostate cancer early, but is not a panacea – it must be used wisely. For men over 45 or 50, especially those with risk factors, it can be a reassuring check. It is important to discuss the results with a doctor who can classify the figures correctly. In this way, the PSA test remains what it should be: a helper for your health.

Editorial office: X-Press Journalistenbüro GbR

Gender note. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple references and gendered designations are avoided for the sake of better readability ected.