High PSA level detected during annual medical check (even though the two earlier years levels where also already high for my age, but still below 4).

Follow-up PSA check at urology department of Japanese Red Cross Medical Center. Free PSA: 15%. MRI is scheduled for 21.8.2014.

MRI findings: prostate cancer in the right lobe, suspected. Free PSA: 12%. Biopsy is recommended.

Free PSA 11%. Upon my request to rule out a prostatitis, the antibiotic Cravit is prescribed for 14 days.

PSA value is still high and free PSA at 12% after antibiotic treatment. Scheduling another MRI at Alta-Klinik in Gütersloh, Germany for 22.12.2014.

MRI findings: suspicious regions in both lobes, MRI-guided biopsy scheduled for the next day.

Laboratory result of the six core needle biopsies: the presence of a carcinoma with a Gleason score of 6 (3+3) in the proximal third of the peripheral zone of the left lateral lobe of the prostate gland; the presence of atypical adenomatous hyperplasia (AAH) in the middle of the peripheral zone of the left lateral lobe; and the presence of pre-malignant high-grade PIN in the distal third of the peripheral zone of the left lateral lobe. The examination also indicates: the presence of a carcinoma with a Gleason score of 7 [3+4 (5%)] in the middle third of the peripheral zone of the right lateral lobe of the prostate gland; the presence of a carcinoma with a Gleason score of 7 [3+4 (10%)] in the distal third of the peripheral zone of the right lateral lobe.
Radical Prostatectomy suggested.

While visiting several medical centers in Japan offering proton therapy to collect information, I submit the biopsy samples to Dr. Tsujii, a fellow of the National Institute of Radiological Sciences in Chiba, Japan for second opinion, and visit the Cancer Institute Hospital of JFCR (Japanese Foundation of Cancer Research), who places me on Active Surveillance. MRI is scheduled for 1.6.2015. In addition it is suggested to refrain from eating meat, especially red meat. After further research I change my diet to exclude any meat (with the exception of fish) and dairy.

MRI findings: the suspected area seems to have extended, and re-biopsy is scheduled for 5.8.2015.

Laboratory result of the 16 core needle biopsies, including 2 targeted: no presence of carcinoma could be found in any of the 16 specimens. Follow-up PSA check is scheduled for 17.12.2015.

During an unrelated blood test regarding a bacterial infection in my leg I ask for my PSA value, which turns out to have dropped below 4.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 14.4.2016.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 17.10.2016.

PSA level measured during annual medical check at Japanese Red Cross Medical Center.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 17.4.2017.

PSA level measured during an unrelated blood test at St. Luke's International Hospital Tokyo.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 30.10.2017.

PSA level measured during annual medical check at Japanese Red Cross Medical Center.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 22.3.2018.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 27.10.2018.

PSA level measured during annual medical check at Japanese Red Cross Medical Center.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 28.3.2019.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 17.10.2019.

PSA level measured during annual medical check at Japanese Red Cross Medical Center.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 9.4.2020, but then delayed to 9.7.2020 due to state of emergency measures to stop the outbreak of coronavirus.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 21.1.2021.

PSA level measured during annual medical check at St. Luke's International Hospital Tokyo.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 15.7.2021.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 13.1.2022. According to my urologist, at the current progression I should not be expected to need any invasive treatment until 60 - 65 years old. Meanwhile he also informed me that heavy (carbon-)ion radiotherapy has become a more common treatment method and is now being covered by Japanese national health insurance. Very happy that I did not opt for the surgery that was so urgently suggested in Germany 7 years ago.

PSA level measured during annual medical check at St. Luke's International Hospital Tokyo.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 11.7.2022.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. As the PSA level has suddenly increased, next check is scheduled in only 3 months for 21.10.2022.

PSA level measured during annual medical check at St. Luke's International Hospital Tokyo.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Next PSA check is scheduled for 24.4.2023.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. PSA level further reduced and free PSA was measured at 0.99, equaling a 12.2% ratio. Upon my inquiry whether it is safe to be treated with the Nanobody compound Ozoralizumab against rheumatoid arthritis, I was advised that because my cancer growth is very slow, there is no concern. Next PSA check is scheduled for 16.10.2023.

`PSA level measured during annual medical check at St. Luke's International Hospital Tokyo.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Free PSA was measured at 1.14, equaling a 11.8% ratio. Next PSA check is scheduled for 18.4.2024.

Follow-up PSA check at the Cancer Institute Hospital of JFCR. Free PSA was measured at 1.19, equaling a 13.9% ratio. My urologist agreed to change the visit schedule to once a year, alternating with my general annual medical check every July. Next PSA check is therefore scheduled for 16.1.2025.

PSA level measured during annual medical check at St. Luke's International Hospital Tokyo.