Prostate cancer is the most common cancer among men – in Germany alone, around 65,000 men receive this diagnosis every year. But although the topic affects many, it is rarely discussed openly.
Many men avoid preventative health checkups or only start thinking about their health when symptoms appear. However, this is especially true for prostate cancer: if detected early, the disease is highly treatable .
But what are the risk factors? Which symptoms should be taken seriously? And does testosterone replacement therapy (TRT) affect the risk of prostate cancer?
The prostate
The prostate is a small but extremely important gland in the male body. It is roughly the size and shape of a chestnut and is located directly below the bladder, surrounding the urethra. Its main function is the production of a special secretion that forms an essential component of seminal fluid. This secretion contains enzymes, proteins, fructose, and zinc, which not only support sperm motility but also serve as an energy source for sperm ( Verze et al., 2016 ).
In addition, the prostate plays a crucial role in controlling urine flow: because it surrounds the urethra, an enlarged or inflamed gland can make urination difficult ( Mobley et al., 2015 ). Furthermore, with increasing age, various prostate diseases can occur – from benign enlargement to malignant changes such as prostate cancer. Therefore, it is particularly important to have the prostate examined regularly by a doctor in order to detect and treat any potential problems early.
Prostate cancer develops when cells in the prostate multiply uncontrollably, forming a tumor. Often, the carcinoma initially grows slowly and remains asymptomatic for years – which is precisely why early detection is so important. Prostate cancer is highly treatable in its early stages, while a late diagnosis makes treatment more difficult.
However, scientific studies show that there are certain risk factors that can significantly increase the risk of developing the disease. Some of these factors are unchangeable, such as age and genetic predisposition, while others – for example, diet and exercise – can be influenced by lifestyle ( Pienta, 1993 ).
Risk factors: What can I do?
1. Age: The most important risk factor
The risk of prostate cancer increases significantly with age. According to epidemiological studies, over 80% of all prostate cancers occur in men over 60. In contrast, men under 50 rarely develop prostate cancer ( Rawla, 2019 ).
2. Genetic predisposition: A family history of the condition doubles the risk.
Genetic factors play a significant role in the development of prostate cancer. Men whose father or brother has prostate cancer have a 2- to 3-fold increased risk of developing the disease themselves ( Hjelmborg et al., 2014 ). Therefore, men with a positive family history of prostate cancer are advised to begin screening earlier.
3. Hormonal factors: Testosterone and prostate cancer
Testosterone, the most important male sex hormone, plays a key role in prostate growth. Therefore, it was long assumed that high testosterone levels increased the risk of prostate cancer. However, current scientific findings show that normal testosterone levels or testosterone replacement therapy (TRT) do not contribute to an increased risk of prostate cancer ( Morgentaler & Traish, 2009 ; Pernar et al., 2018 ). Regular medical checkups are nevertheless recommended.
4. Lifestyle and nutrition: Influence of fat, sugar and exercise
Lifestyle factors such as diet and exercise are playing an increasingly important role in cancer research. Studies have shown that unhealthy eating habits can increase the risk of prostate cancer.
Dietary factors that can increase the risk:
-
High fat consumption: A diet high in fat – especially saturated fats from red meat and processed foods – is associated with a higher risk ( Pelser, 2013 ).
-
Excessive sugar consumption: Elevated insulin levels and metabolic disorders promote inflammatory processes that can favor the growth of cancer cells ( Giovannucci et al., 2010 ).
-
Low vegetable and fiber intake: A diet low in fruit, vegetables, and antioxidants can make the body more susceptible to cell damage. However, there is evidence that coffee, tea, and lycopene from tomatoes may have protective effects ( Vance et al., 2013 ).
Positive factors that reduce the risk:
-
Mediterranean diet: Rich in omega-3 fatty acids, antioxidants and healthy fats – studies show that men with this diet have a lower risk of prostate cancer ( Dhillon, 2022 ).
-
Regular exercise: Physical activity not only reduces the risk of aggressive tumor forms, but also improves the overall hormonal balance ( Friedenreich et al., 2016 ).
Recognizing prostate cancer: Symptoms you shouldn't ignore
Prostate cancer is one of the most insidious cancers because it often causes no symptoms in its early stages . This is precisely what makes it so dangerous: many men only notice symptoms when the tumor has already grown or spread to surrounding tissue ( Rawla, 2019 ).
Therefore, it is crucial to attend regular check-ups – especially from the age of 45 or earlier if there is a family history of prostate cancer. Nevertheless, there are some warning signs that men should take seriously. Keep in mind that the symptoms can also be caused by other conditions, such as benign prostatic hyperplasia (BPH) or prostatitis.
1. Changes in urination
Because the prostate gland surrounds the urethra, a growing tumor can obstruct urine flow. The following symptoms often occur:
-
Frequent urination, especially at night (so-called nocturia)
-
Weak or interrupted urinary stream ( Gnanapragasam et al, 2022 )
-
Difficulties urinating, such as pain or a burning sensation
-
Blood in the urine (hematuria) ( Hansen et al, 2022 )
2. Pain in the pelvic area, groin or lower back
If a tumor is already present, further symptoms can arise due to its spread to surrounding tissues, including:
-
Chronic pelvic pain, including pain in the groin area
-
Lower back pain ( Ruppert et al. 2022 )
Back pain in prostate cancer often occurs as part of an advanced stage of the disease, especially when metastases have spread to the spine or pelvis.
3. Erectile dysfunction (ED)
Since the prostate is closely connected to the nerve pathways responsible for erectile function, tumor growth or treatments such as surgery and radiation can impair potency ( Hyun et al. 2012 ).
4. Unintentional weight loss and chronic fatigue
Rapid, unintentional weight loss within a few months may indicate advanced cancer ( Nicholson et al. 2020 ). Furthermore, men with prostate cancer often report persistent exhaustion and chronic fatigue that are not attributable to lack of sleep or stress ( Schmidt et al., 2020 ).
So how can you recognize a change early on?
Preventive check-ups: the be-all and end-all
Regular preventive check-ups are key to early detection and can significantly improve the chances of recovery ( Rawla, 2019 ).
PSA test (prostate-specific antigen) – the most important blood test
What is the PSA test?
-
The PSA test measures the concentration of prostate-specific antigen (PSA) in the blood.
-
PSA is a protein produced by the prostate gland and can be detected in small amounts in the blood ( Loeb et al., 2017 ).
How is the PSA test interpreted?
-
An elevated PSA level can indicate a benign condition . Prostate enlargement, inflammation or prostate cancer may be indicated ( Carlsson et al., 2022 ).
-
An increase in PSA levels compared to a previous measurement ( so-called PSA velocity ) or a value above 4.0 ng/ml is often considered abnormal, but lower values can also indicate disease ( Prostate Cancer Guideline ).
Possible harmless causes for an elevated PSA level
However, since PSA levels can also be elevated due to far less serious causes , and a low PSA level does not rule out cancer, it should always be evaluated in combination with other tests ( Verbeek et al. 2018 ). Non-pathological factors that can lead to an elevated PSA level include:
-
Ejaculation within the last 24–48 hours
-
Cycling or other mechanical stresses on the prostate
-
A recently performed digital rectal examination (DRE)
-
Urinary tract infections or acute prostatitis
-
Age-related fluctuations in PSA levels
Age-dependent PSA normal values
PSA levels are also age-dependent , as the prostate gland enlarges with age and naturally produces more PSA. Therefore, the following age-dependent PSA threshold values serve as guidelines:
-
40–49 years: up to 2.5 ng/ml
-
50–59 years: up to 3.0 ng/ml
-
60–69 years: up to 4.0 ng/ml
-
Ages ≥ 70: up to 5.0 ng/ml
However, these values are not absolute and must be considered individually ( PSA value determination | Prostata.de , nd ).
PSA velocity (climbing speed)
Not only the absolute PSA value is relevant, but also how quickly it rises . The so-called PSA velocity describes the change in the PSA value over time . An increase of more than 0.75 ng/ml per year can indicate a malignant change and should be investigated further ( PSA level determination | Prostata.de , nd ).
PSA ratio (fPSA/tPSA)
The PSA ratio indicates the ratio of free PSA (fPSA) to total PSA (tPSA) .
-
fPSA/tPSA > 25% → more likely an indication of benign prostatic hyperplasia
-
fPSA/tPSA < 10% → may indicate a malignant change
( Prostate: Free PSA/Total PSA Ratio | Laboratory Dr. Wisplinghoff , nd )
Digital rectal examination (DRE) – the classic palpation of the prostate
During a digital rectal examination (DRE), the doctor inserts a finger into the rectum and palpates the prostate gland for abnormalities such as hardening or nodules. The examination only takes a few seconds, but is uncomfortable for many men – nevertheless, it is an important part of preventative care. It serves as a supplementary examination to the PSA test and can detect moderate to significant changes in the prostate.
When should you go for a check-up?
Regular prostate cancer screenings are crucial for early detection and maximizing the chances of a cure. The German Cancer Society recommends the following examination intervals:
-
From the age of 45, men should have a prostate examination once a year . This usually includes a PSA test (prostate-specific antigen) and a digital rectal examination (DRE) , in which the doctor palpates the prostate for abnormalities.
-
Men with a family history of the disease should begin preventive care as early as age 40. Studies show that a genetic predisposition significantly increases the risk of developing the disease, which is why early monitoring is advisable ( Hjelmborg et al., 2014 ).
-
From the age of 50, the examination interval can be extended to every two years , provided that previous findings were unremarkable and no additional risk factors exist.
The earlier prostate cancer is diagnosed, the better the treatment options. While it often grows slowly, in more aggressive cases early detection can be lifesaving. Regular checkups therefore offer the best chance of detecting any changes early and treating them effectively.
You can find out more about preventative care in our article " Preventative check-ups for men: Act early, stay healthy ".
The link between testosterone and prostate cancer: A myth?
For a long time, it was assumed that testosterone replacement therapy (TRT) increased the risk of developing prostate cancer. However, more recent scientific studies refute this theory and show that there is no direct link between TRT and an increased risk of prostate cancer ( Morgentaler & Traish, 2009 ; Michaud et al., 2015 ). In fact, some studies suggest that very low testosterone levels may be associated with more aggressive tumor progression, as testosterone plays a regulatory role in prostate cell growth ( Morgentaler & Traish, 2009 ; Safi et al., 2024 ).
Nevertheless, men receiving or considering TRT should be regularly monitored by a physician. PSA (prostate-specific antigen) levels should be checked regularly to detect changes early ( Pernar et al., 2018 ). Close monitoring is particularly important for men with a family history of prostate cancer or existing prostate disease. Therefore, current data do not argue against TRT, but rather emphasize the importance of regular check-ups to identify potential risks early and assess them individually.
Our conclusion, your knowledge
Prostate cancer is the most common cancer in men, but the good news is: if detected early, the chances of a cure are very high . Since the disease usually causes no symptoms in its early stages, regular checkups are essential.
Scientific findings show that age, genetic predisposition, hormonal factors, as well as diet and lifestyle are significant risk factors. While age and genetic predisposition cannot be changed, men can actively contribute to prevention through a healthy diet, regular exercise, and conscious health management. Take care of yourself and get regular checkups!
Prevention starts with small steps. At Adon Health, you'll find tailored solutions for your health – from innovative blood tests to personal consultations. Strengthen your body and mind – for a life full of energy and vitality!
