“The best time to plant a tree was twenty years ago. The second best time is now.” This old wisdom gets to the heart of prostate care. Prostate cancer is often asymptomatic in its early stages – those who wait lose time. Those who act wisely gain years of health, energy, and control over their own performance.

The prostate is a walnut-sized gland located beneath the bladder. With age, benign changes and inflammations accumulate; it is crucial to recognize clinically relevant tumors early. The PSA levelprotein in the blood predominantly produced by the prostate; elevated levels may indicate inflammation, enlargement, or cancer is not proof of cancer, but a risk signal. The digital rectal examination (DRE)palpation of the prostate through the rectum to identify hardening or nodules complements the PSA, especially for palpable, more aggressive findings. Modern imaging techniques such as mpMRImultiparametric magnetic resonance imaging; shows abnormal areas, reduces unnecessary biopsies and precision biomarkers are sharpening diagnostics today. The goal is a risk-adapted early detectionintervals and intensity of examinations are based on individual risk, enabling high performers to plan their care efficiently and with minimal burden.

Those who check early prevent late consequences. A risk-adapted approach with baseline PSA in middle age allows for longer intervals at low values and targeted clarification only in cases of elevated risk – this reduces overdiagnosis and unnecessary interventions, without missing relevant tumors ^[1]. DRE can provide indications of more aggressive, peripherally located tumors and support the decision for biopsy in cases of elevated PSA ^[2]. Additionally, lifestyle factors play a significant role: a healthy weight, regular exercise, and a predominantly plant-based diet correlate with lower risk and better outcomes – a benefit that supports prevention, therapeutic success, and everyday performance ^{[3] [4]}. Moreover, updated risk calculators and biomarkers enhance individual assessments and help avoid unnecessary repeat biopsies after an initially unremarkable finding ^{[5] [6]}.

The current German guidelines recommend a risk-adapted early detection with a baseline PSA around the age of 45. If the value is below 1.5 ng/mL, longer intervals are sufficient; tighter controls are sensible for values between 1.5 and 3 ng/mL. For confirmed values over 3 ng/mL, a structured urological evaluation follows, typically including mpMRI and possibly biopsy. This PSA-MRI model increases the detection rate for clinically significant tumors and reduces unnecessary diagnostics; it has also expanded the scope for active surveillance of low-risk tumors ^[1]. Concurrently, reviews indicate that diagnostics are shifting from "PSA alone" to multimodal pathways involving mpMRI, PSMA-PET/CT, and new biomarkers. The aim is to identify aggressive tumors earlier and avoid overtreatment of harmless findings; initial reports even discuss treatment pathways with minimal or no traditional biopsy in strictly selected cases, underscoring the evolution ^[7]. In clinical practice, DRE remains a pragmatic tool: prospective data confirm solid diagnostic accuracy in suspected cases; positive DRE findings occur more frequently in peripheral and higher-grade tumors – an indication that can sharpen the indication for biopsy ^[2].

- Establish a risk-adapted screening: Get a baseline PSA around age 45. Below 1.5 ng/mL, a check every 5 years is sufficient; between 1.5–3 ng/mL, checks should be done every 2 years; above 3 ng/mL: confirm PSA, then consider urological evaluation with mpMRI ^[1].
- Actively address the DRE: Particularly with elevated PSA, the examination can help to better assess urgency and potential aggressiveness ^[2].
- Utilize modernized diagnostic pathways: For suspected cases, schedule mpMRI before biopsy; inform yourself about new imaging and biomarkers that reduce overdiagnosis and more accurately detect relevant tumors ^{[7] [1]}.
- Optimize your lifestyle: Maintain a healthy weight, exercise 150–300 minutes per week aerobically plus 2–3 strength training sessions, and eat a predominantly plant-based diet (vegetables, fruits, whole grains, legumes, nuts, olive oil, fish). Limit red and processed meats as well as highly processed foods. These patterns correlate with lower risk and better outcomes ^{[3] [4]}.
- Focus on protective dietary components: Lycopene-rich foods (e.g., tomato products), omega-3-rich fish, and polyphenol-rich diets support anti-inflammatory and hormonal balance – beneficial as part of an overall diet ^{[4] [3]}.
- Check digital risk calculators: Use validated online tools for personal risk assessment and decision-making assistance before biopsy or therapy. Updated calculators incorporate additional markers such as %freePSA and [-2]proPSA to improve predictive power; medical advice remains essential ^{[6] [8] [5]}.
- Stay updated with research: Follow guidelines updates and new recommendations on screening intervals, imaging, and active surveillance to achieve maximum protection with minimal burden ^{[1] [7]}.

Prostate diagnostics are becoming richer in data, more precise, and more personalized. In the coming years, combined algorithms from PSA trends, mpMRI, biomarkers, and digital risk calculators will continue to refine screening and treatment decisions. Those who engage in risk-adapted care today and wisely adjust their lifestyle hold the best cards for longevity and performance tomorrow.