Complaints & connections · borters.ch
A single raised PSA is repeated first — and today the MRI comes before the tissue sample.
Also known as: prostate cancer · PSA-based screening
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Prostate cancer is the commonest cancer in men and at the same time the one with the widest range: some grows so slowly that it never causes anything in a lifetime, some is serious and has to be found early. The whole difficulty of screening arises from exactly that — it is not about finding as much as possible but about finding the right thing. The PSA value is a sensitive but unspecific indicator: it also rises with benign enlargement, with inflammation, after cycling, after sex and after an examination. A single raised value therefore means, at first, only one thing — repeat it calmly a few weeks later. If it is confirmed, the road onward has changed fundamentally in recent years: before the tissue sample comes magnetic resonance imaging today. If that is unremarkable, the biopsy can often be avoided; if it is suspicious, the sample is taken there specifically. That spares many men a procedure and at the same time finds fewer of the harmless findings that only worry. If a slow-growing cancer is found, active surveillance is a recognised choice and not doing nothing. Whether to start measuring at all is a decision that belongs to the man.
Four to six weeks later, without a preceding examination, without cycling the day before and not during an infection. A considerable share of raised values normalises by itself this way.
This is the most important change of recent years. An unremarkable scan spares many men the tissue sample; a suspicious one leads to a targeted rather than a blindly distributed sample. Asking for it is worthwhile — it is not standard everywhere.
With slow-growing findings there is no treatment but monitoring — with PSA, imaging and an occasional sample. That is a recognised choice, not a postponement, and it avoids the effects on continence and erection as long as nothing happens.
One sheet with all PSA values and dates, including from earlier years and other practices. The curve answers questions that a single number leaves open.
What is gained, what is risked? Screening lowers the risk of dying from this cancer but also leads to diagnoses that would never have caused complaints. Both belong on the table before the first value is measured — afterwards the question is no longer open.
An inflammation of the prostate lifts the PSA markedly and then settles again. With pain at the perineum, burning or fever one therefore treats first and measures four to six weeks later.
About one man in eight receives the diagnosis in his lifetime, but many more carry the tumour without ever knowing: from eighty it is found in roughly half at autopsy. Many forms grow so slowly that watching replaces treating — a recognised strategy, not doing nothing.
In slow-growing tumours, active surveillance is a route in its own right, not doing nothing: regular PSA checks, MRI and biopsies, and treatment only when something changes — which spares a large share the effects on continence and potency. Anti-hormone treatment takes testosterone away from the tumour; it slows it, it does not remove it, and over years it costs bone density and muscle. Strength training during that time is the most effective counterweight.
Movement maintains strength and weight during treatment. Under androgen deprivation therapy, bone and muscle break down as well — strength training works precisely against that. What is possible and how much depends on the treatment phase and belongs with the treating team.
A weak stream, frequent passing of water and getting up at night almost always come from the benign enlargement. The cancer usually grows at the edge of the gland and does nothing for a long time — so it cannot be recognised from how one feels.
Between two measurements the same man can have clearly different values. Repeating after a few weeks, calmly and without an infection, clears up a good share of raised values by itself.
A father or brother with prostate cancer, especially at a younger age, brings the question forward. Breast and ovarian cancer in the family count too, because certain inherited genes affect both.
The development says more than a single number. So it is worth collecting all values with their dates — including those from other practices.
Anyone who, because of age or other illness, can no longer expect ten to fifteen years of benefit gains nothing from the search and risks burdensome workups and treatments. That belongs discussed openly.
Do not measure during an infection or after cycling, sex or an examination — it rises then without cancer. A drug from the 5-alpha-reductase inhibitor group halves it; under one, the value is read doubled.
Helps in the grey zone to separate benign from malignant causes: a high free share speaks more for the benign enlargement. It does not replace imaging but can save a biopsy.
Only of significance once the disease is established: a rise can point to involvement of the bones. In screening this value plays no role.
Belongs alongside when the bladder empties poorly or a treatment is coming. Back pressure up to the kidneys shows here first.
The loss of muscle mass helps decide how well a treatment is tolerated. Enough protein spread across the day, together with movement, is the part one holds oneself.
Low values are common with a longer illness, and correcting them counts for bone and muscle. For high-dose courses against the illness itself there are no studies; they can interfere with treatment.
Belong in the workup of an anaemia that is otherwise too quickly put down to the illness or the treatment. Both are easy to measure and easy to supplement.
Nausea, diarrhoea and fever dry one out quickly, and several treatments strain the kidney. Drinking enough is no side issue here.
One of the clearest examples of a refuted hope. The large SELECT trial with 200 µg selenium and vitamin E over 5 years found no protection — in the vitamin E arm more prostate cancers even occurred. In men with high selenium levels, selenium was linked with more aggressive forms.
In observational studies men with less prostate cancer eat more tomato products. In the capsule studies this could not be confirmed — and lycopene from cooked tomato with oil is absorbed distinctly better than from raw.
Important for early detection: saw palmetto does not lower PSA — finasteride and dutasteride do, by about half. Anyone taking those must tell the laboratory, otherwise a raised value is read as normal.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Clearly worthwhile and well supported when deficient — vegan, older adults, certain drugs. No energy boost without a deficiency.
The growth of these cells depends on male hormones. The hormone-withdrawing treatment rests on that — and its side effects follow from it: hot flushes, loss of muscle, loss of bone, changed mood.
The form that acts in the prostate. Drugs that block its formation halve the PSA value — under them the value is read doubled.
The signal from the pituitary gland that drives the testicle. The usual hormone treatment acts at exactly this point, not on the testicle itself.
Observational studies find fewer advanced findings with plenty of cooked tomatoes and broccoli. Intervention studies could not confirm it — the link stays observational.
Above about 2000 mg a day over years cohorts show more frequent findings. The normal need of 1000 mg is not what is meant.
The claim usually rests on the PET scan: weakly radioactive glucose is injected, and the tumour lights up. That shows tumour cells take up sugar faster than the tissue next to them — not that eaten sugar feeds them. You come to a PET scan fasting, and the tumour lights up anyway; the body keeps blood sugar within narrow limits by itself. It cannot be starved out this way. There is an established link nonetheless, but it runs through body fat: in 2016 the International Agency for Research on Cancer (IARC) reviewed the available studies and found sufficient evidence, for thirteen cancers, that absence of excess weight lowers the risk. That concerns prevention — it is not an answer to where an existing illness came from.
In cohorts regular movement after diagnosis is linked with a better course. On hormone deprivation therapy strength training is additionally important, because muscle and bone break down.
On hormone deprivation bone density falls markedly. Vitamin D and calcium then belong alongside — that is bone protection, not cancer treatment.