The prostate is a small but important organ in the male body. About the size of a walnut and located directly below the bladder, it surrounds the upper part of the urethra. The prostate's main function is to produce a portion of the seminal fluid necessary for reproduction. In everyday life, most men are unaware of their prostate – until it starts causing problems.

Why the prostate becomes important

As men age, their prostate gland changes. It grows, and this growth can lead to problems. Benign prostatic hyperplasia (BPH), also known as benign enlargement of the prostate, is extremely common: By age 50, about half of all men are affected, and by age 80, it's over 80 percent. This enlargement is not a precursor to cancer, but it can significantly impair quality of life. At the same time, prostate cancer is the most common cancer among men in Germany. Approximately one in eight men will develop it during their lifetime. The good news is that if prostate cancer is detected early, the chances of a cure are excellent. That's why preventative care is so important.

The problem with silence

Many men find it difficult to talk about the prostate. The organ is associated with sexuality, examinations are perceived as unpleasant, and problems like frequent urination are considered embarrassing. This reluctance can be dangerous. Those who ignore symptoms or avoid preventative care risk having diseases discovered only in advanced stages. It's time to destigmatize the prostate. It's a normal part of the male body, and talking about it is just as normal as talking about the heart or lungs.

Benign prostatic hyperplasia (BPH) is a normal part of aging in men. It is not related to cancer and does not increase the risk of cancer. Nevertheless, it can cause significant discomfort because the growing prostate gland presses on the urethra and obstructs the flow of urine.

Typical symptoms

The symptoms usually develop gradually over years. Many men become accustomed to them and consider them a normal part of aging. Among the most common complaints is increased urinary frequency, especially at night, known as nocturia. Having to get up two or more times during the night significantly disrupts sleep. A weakened urine stream is characterized by a weak, sometimes intermittent, flow of urine rather than a strong one. The sensation of incomplete emptying means that after urinating, the bladder feels as if it is not completely empty. Post-void dribbling is bothersome and can lead to damp patches. Delayed onset means that it takes some time for the urine flow to begin, even when the urge is strong. Urgency is characterized by a sudden and strong urge to urinate, which is sometimes difficult to control.

When to see a doctor.

These symptoms should always be medically evaluated, not to downplay them, but to rule out other causes. Similar symptoms can also be caused by bladder problems, urinary tract infections, or, in the worst case, prostate cancer. Effective treatments are available: medications can alleviate symptoms and slow prostate growth. In severe cases, various surgical procedures are possible. Don't wait until the symptoms become unbearable. The earlier treatment begins, the better the results.

With around 65,000 new cases per year, prostate cancer is the most common type of cancer among men in Germany. This sounds alarming, but the figures also have a positive side: most prostate carcinomas grow slowly, and with early detection, the chances of a cure are very good. The relative 5-year survival rate is over 90 percent.

Know the risk factors

Age is the most important risk factor. Prostate cancer before the age of 50 is rare; the average age of diagnosis is around 70. A family history significantly increases the risk. If a father or brother has had prostate cancer, the individual's own risk is about two to three times higher. With several affected relatives, the risk increases further. Ethnic origin plays a role: Men of African descent have a higher risk and often develop the disease at a younger age. Men of Asian descent have a lower risk. Lifestyle factors appear to play a role. A high-fat diet with plenty of red meat could increase the risk, while a vegetable-rich, Mediterranean diet might have a protective effect. However, the evidence is less conclusive than for other types of cancer.

Symptoms in the early stage

The insidious thing about prostate cancer is that it usually causes no symptoms in its early stages. When symptoms do occur, they often resemble those of benign prostatic hyperplasia (BPH): difficulty urinating, frequent urges to urinate, and a weak urine stream. In advanced stages, blood in the urine or semen, pain in the pelvis, lower back, or hips, and bone pain (in the case of bone metastases) can occur. Because early symptoms are often absent, preventative care is so important. Without proactive early detection, prostate cancer is often only discovered in advanced stages.

Prostate cancer screening in Germany includes various examinations, some of which are covered by health insurance, while others must be paid for out of pocket. It's worthwhile to know the options and make an informed decision.

Digital rectal examination (DRE)

During this examination, the doctor palpates the prostate gland with a finger through the rectum. This sounds unpleasant, but it only takes a few seconds and is barely painful. The doctor can then assess the size, shape, and consistency of the prostate. Hardening or nodules can be indicators of cancer. Digital rectal examination (DRE) has its limitations: only the posterior part of the prostate can be felt, but this is where most tumors develop. Small tumors can be missed. Nevertheless, DRE is an important part of preventative care and, from the age of 45, is part of the statutory early detection program.

PSA test

The PSA test measures prostate-specific antigen in the blood. PSA is a protein produced by the prostate gland. Elevated levels can indicate prostate cancer, but can also have many other causes: benign enlargement, inflammation, or prostate strain after physical exertion. The PSA test is not covered by health insurance because it can lead to false-positive results—that is, elevated levels without cancer—and thus to unnecessary further examinations and anxiety. Conversely, cancer can also be present with normal PSA levels. Despite these limitations, the PSA test can be useful, especially in combination with other examinations. Individual consultation is important: not every man needs a PSA test, but some benefit from it.

Transrectal ultrasound (TRUS)

In this examination, an ultrasound probe is inserted into the rectum to visualize the prostate. TRUS is not routinely used for screening, but rather for further investigation when abnormal findings are present. TRUS can identify suspicious areas from which tissue samples can then be taken.

The PSA level is an important but often misunderstood marker. It indicates how much prostate-specific antigen is present in one milliliter of blood. However, a single PSA value is not very informative – the trend over time and the context are crucial.

What is 'normal'?

Traditionally, a PSA level below 4 ng/ml is considered normal. However, this threshold is a significant oversimplification. Younger men have lower levels, while higher levels are normal in older men. A 50-year-old with a PSA of 3.5 has a higher risk than a 75-year-old with the same level. Some experts recommend age-dependent thresholds: below 2.5 ng/ml for men under 50, below 3.5 ng/ml for men between 50 and 59, below 4.5 ng/ml for men between 60 and 69, and below 6.5 ng/ml for men over 70. These values ​​are guidelines, not rigid limits.

Causes of elevated levels

An elevated PSA level does not automatically mean cancer. Other causes include benign prostatic hyperplasia (BPH), where the enlarged prostate produces more PSA. Prostatitis, or inflammation of the prostate, can significantly increase PSA levels. PSA can temporarily rise after ejaculation, which is why abstinence for two to three days is recommended before blood is drawn. Cycling and other mechanical irritation of the prostate can affect the level. Some medications, such as 5-alpha reductase inhibitors, lower PSA, which must be taken into account when interpreting the results.

Monitor PSA levels

More informative than a single value is the trend over time. The PSA velocity, i.e., how quickly the PSA level rises, can provide clues. A rapid rise is more suspicious than a slow one. Therefore, it is recommended to document and compare PSA levels during regular checkups. If abnormal values ​​are found, a follow-up measurement is usually performed before further steps are taken.

The question of when and how often prostate cancer screening should begin depends on individual factors. The statutory early detection examination provides a framework, but the same approach is not suitable for every man.

Legal recommendations

In Germany, men aged 45 and over are entitled to an annual prostate cancer screening, which is covered by health insurance. This includes a digital rectal exam and a consultation. The PSA test is not covered by health insurance but can be paid for privately as an individual health service (IGeL).

Start earlier if the risk is increased.

Men with a family history of prostate cancer should start screening earlier. If a father, brother, or several male relatives have had prostate cancer, starting at age 40 is often recommended. In such cases, an early baseline PSA test can also be useful to assess the progression of the disease later.

Individual decision

The decision for or against certain preventative measures should be made on an individual basis. This is especially true for the PSA test. Factors that should be considered include your individual risk profile, age and life expectancy, your attitude towards the potential consequences of an abnormal result, and your personal preferences. An open conversation with your doctor is important. Have the advantages and disadvantages of the different options explained to you, and then make an informed decision.

Prevention is more than just visiting the doctor.

In addition to medical checkups, self-observation is important. Pay attention to changes in urination, blood in your urine or semen, or unexplained pain in your pelvis or back. If anything is different than usual, talk to your doctor – even between regular checkups.

While you can't change your age or your genes, you can influence many lifestyle factors. Science increasingly shows that certain behaviors can promote prostate health.

Nutrition and prostate

A balanced, plant-rich diet appears to support prostate health. Tomatoes, especially cooked ones, contain lycopene, an antioxidant that has been linked to a lower risk of prostate cancer in studies. Cruciferous vegetables such as broccoli, cauliflower, and cabbage contain sulforaphane, which may have protective properties. Fatty fish with omega-3 fatty acids may have anti-inflammatory effects. Soy and soy products contain isoflavones, which are correlated with lower rates of prostate cancer in Asian populations. Conversely, it is recommended to limit red and processed meat, reduce excessive dairy consumption, and restrict sugar and highly processed foods. These associations are not as strong as those for lung cancer and smoking, for example, but they provide clues for a health-promoting diet.

Movement and weight

Regular physical activity is associated with a lower risk of prostate cancer and better outcomes for those already affected. Being overweight, especially with abdominal fat, is a risk factor for more aggressive forms of prostate cancer. Exercise therefore helps in two ways: directly through potential protective effects and indirectly through weight control.

Other factors

Smoking does not increase the risk of developing prostate cancer, but it does increase the risk of dying from it. Therefore, not smoking is also relevant for prostate health. Moderate alcohol consumption does not appear to significantly affect the risk of prostate cancer, while excessive consumption is harmful for many other reasons. Regular sexual activity has been associated with a lower risk of prostate cancer in some studies, but the evidence is not conclusive.

A prostate cancer diagnosis is initially a shock. But in most cases, there's no reason to panic. Prostate cancer is often very treatable, and various treatment options are available.

Active monitoring

For slow-growing, less aggressive tumors, active surveillance may be the best option. This involves close monitoring of the tumor, but not immediate treatment. The idea is that many prostate cancers grow so slowly that they will never cause problems. Immediate treatment with its potential side effects would then be overtreatment. Active surveillance includes regular PSA tests, digital rectal exams, and biopsies at specific intervals. If the tumor grows or becomes more aggressive, treatment can be initiated at any time.

Surgical treatment

Radical prostatectomy, the complete removal of the prostate gland, is a standard treatment for localized prostate cancer. It can be performed via open surgery, laparoscopically, or robotically. The goal is the complete removal of the tumor with the intention of achieving a cure. Possible side effects include incontinence and erectile dysfunction, with the risks depending on the surgeon's experience and the chosen method.

radiotherapy

As an alternative to surgery, radiation therapy can be performed, either externally or by inserting radioactive seeds into the prostate, a procedure called brachytherapy. In many cases, the results are comparable to surgery. However, there are also risks of side effects affecting the bladder and bowel, as well as erectile function.

Further options

For advanced or metastatic tumors, hormone therapy, chemotherapy, and newer targeted therapies are used. Treatment is individually tailored and often discussed in tumor boards where various specialists meet.

Deciding to take proactive preventative measures is the first step. A prostate cancer screening test allows you to conveniently determine an important marker from home and thus gain an overview of your current status.

What the PSA test reveals

A prostate cancer screening test typically measures the PSA level in the blood. As previously explained, this value is an important component in prostate diagnostics. A low, stable PSA level is reassuring. An elevated or rising level should be discussed with a doctor and investigated further. The major advantage of a home test is its accessibility: many men who are hesitant to visit a urologist can gain an initial overview this way. If the results are abnormal, a doctor's visit is then the next logical step.

For whom is a test useful?

A prostate cancer screening test can be useful for men aged 45 and over who want to determine their baseline PSA level, for men with a family history of prostate cancer from around age 40, for monitoring between doctor's visits if a PSA level is already known, and for anyone who wants to know more about their prostate health. The test does not replace a physical examination with a digital rectal exam, but it complements it effectively. The trend in PSA levels over time is particularly informative, so regular testing can be valuable.

Correctly classifying results

It's important to see the results in the right context. A slightly elevated value doesn't automatically mean cancer. Conversely, a normal value doesn't completely rule out cancer. The results should be discussed with a doctor who can assess the overall situation. But even a normal result is valuable information – it provides reassurance and motivates you to continue preventative care.

The prostate is an organ that will play a role in most men's lives at some point – whether through benign enlargement, a routine check-up, or, in the worst case, a cancer diagnosis. Those who are informed and take preventative measures have the best chance of detecting problems early and treating them successfully.

The most important messages

Prostate cancer is common but often highly treatable, especially when detected early. Benign prostatic hyperplasia (BPH), also known as benign prostatic enlargement, is even more common and can affect quality of life, but it is not a precursor to cancer. Symptoms related to urination should not be ignored, even if they often have harmless causes. Preventive screening is recommended starting at age 45, or at age 40 if there is a family history of prostate cancer. The PSA test has advantages and disadvantages and should be chosen after individual consultation. Lifestyle influences prostate health and can affect risk.

Concrete steps

If you're over 45 and have never had a prostate cancer screening, make an appointment with a urologist or general practitioner. If prostate cancer runs in your family, start screening earlier, ideally from age 40. Pay attention to any changes in your urination and discuss them with your doctor. Consider having a baseline PSA test to monitor your progress later. Review your lifestyle and identify areas where you can improve your health.

A personal appeal

Preventive care isn't a weakness or excessive worry. It's a responsibility – to yourself and to the people who need you. A few minutes of examination can mean years of healthy life. Take your prostate seriously, but don't let fear paralyze you. Get informed, get checked, and then enjoy life – with the peace of mind that comes with knowing you did the right thing.