The laboratory examinations carried out in the practice include in particular the examination of urine for pathological contents (blood, bacteria, crystals and tumour cells) as well as the cultivation, identification and resistance testing of pathogens in urine and other body fluids. These examinations, carried out quickly and close in time, enable us to carry out a targeted therapy and, if necessary, a rapid adjustment of our therapy in the case of, for example, bacterial diseases in the urinary tract.
In order to examine the urine, it is necessary to obtain the so-called midstream urine. Here you should empty the first urine into the toilet so that the urethra is flushed free of bacteria. You should then collect a 50-100 ml portion of urine. Please empty the rest of the bladder contents into the toilet.
In the case of special questions, such as the clarification of protein excretion in the urine or the determination of stone-forming substances, it is necessary to collect the urine for 24 hours. In this case, all urine is collected from a certain point in time (typically in the morning after urination and defecation) until the same time the next day in a collection container provided. The examination of semen samples (spermiogram) is crucial for successful diagnosis and control of treatments in cases of unfulfilled desire to have children. These examinations allow us to draw conclusions about the causes of an unfulfilled desire to have children. These samples are collected promptly by the patient at home. No more than 60 minutes should elapse between the collection of the sample and the examination and no ejaculation should have taken place in the last 5 days before the examination. A neutral transport container will of course be provided for the collection of the sample. An examination for pathogenic germs in the seminal fluid will also be carried out in the laboratory if necessary.
Other laboratory tests which are carried out by blood tests, such as PSA (prostate specific antigen), testosterone (male sex hormone), FSH, LH or prolactin (control hormones of the seminal filament and hormone production) are also forwarded to a specialist laboratory to be carried out.
In addition, there is the possibility of chemical stone analyses for patients with urinary stone disease. The results can (but do not have to) provide valuable information for a special dietary therapy.
The PSA test for early detection of prostate cancer
Pros and cons
According to current figures, the most common cancer in men is prostate carcinoma, with about one fifth of all male cancer patients suffering from it. Every year, doctors diagnose about 40,000 new cases and over 11,000 deaths due to prostate carcinoma. Prostate cancer is currently the most commonly diagnosed tumour in men over the age of 50.
Prostate carcinoma is considered a „typical“ disease of old age, which means that the disease becomes more likely with increasing age. According to the Robert Koch Institute (www.rki.de), about 59 men per 100,000 people in Germany were diagnosed with prostate carcinoma by the age of 45 in 2000, while in the age group of men over 75, 2,864 out of 100,000 were affected for the first time. Prostate carcinoma is predominantly a glandular cancer, originating from the cells of the outer parts of the glands. The causes are largely unknown.
Most men are not aware of the possible dangers of prostate carcinoma, but also of the possibility of early detection. Only 15-20 per cent use the preventive examinations offered by the health insurance companies. But especially in the case of prostate cancer, the earlier it is detected, the better the chances of cure. With the current state of medicine, 90 percent of cases can still be cured at an early stage.
The disease causes only a few symptoms at first, which are often ignored by patients. This is not only due to a general negligence with regard to participation in preventive measures, but also to feelings of shame: the previously common rectal examination is perceived as embarrassing. For many patients, fear of possible side effects of cancer therapy, such as loss of erectile function and the risk of incontinence, also plays a role. Finally, the knowledge of the lack of effectiveness of the examination does not motivate participation.
The digital rectal examination (DRU) is the most common method for early detection. However, the detection rate of early-stage tumours through pure palpation is extremely low. Only 8 to 17 percent of tumours are detected by palpation, provided they are located in a region accessible to the finger and have already reached a size of more than one cubic centimetre.
Therefore, in addition to the rectal digital examination, the value of the PSA determination in the blood is currently being discussed. With the help of the PSA value, early tumours that are not yet palpable can also be detected. The blood test (blood from the arm vein) can determine the concentration of the prostate-specific antigen (PSA), a protein body formed exclusively in the prostate tissue. If the concentration of PSA exceeds a certain value, this can be an indication of prostate cancer. The emphasis is on the word „can“: because an elevated value does not necessarily mean cancer, but can also be caused by other diseases or physical activities such as cycling in the short term.
Due to the accusation of a „false alarm“, premature tissue sampling (biopsies), possible damage from initiated therapy measures and, last but not least, the still outstanding scientific proof of the benefit of the PSA determination for the early detection of prostate cancer, the PSA test has come under discussion. In the case of an elevated PSA value, the doctor can clarify through further examinations whether it is cancer or not.
If a tumour is detected, this does not mean that it has to be treated with radiation or operated on immediately. The doctor will try to determine the aggressiveness of the tumour – in the case of slow-growing tumours and at an older age, „controlled observation“ is often the recommended therapy.
It is often thanks to the PSA test that the tumour is detected at a stage where it can still be cured. The costs for a PSA test are currently not (yet?) covered by the statutory health insurance funds.