Prostate cancer

Prostate cancer is the most common cancer in men in Slovenia, with around 1,878 new cases diagnosed each year. The risk of developing it increases with age. It often develops slowly and causes no typical symptoms for a long time, which is why early detection and accurate diagnosis are essential. Men are advised to have their first preventive examination with a urologist after the age of 50.

About prostate cancer

Prostate cancer is a malignant growth within the prostate caused by the uncontrolled growth of the prostate's glandular cells (adenocarcinoma). Because it most often develops in the peripheral zone of the prostate, a urologist can feel it during a digital rectal examination.

Many factors influence the development of prostate cancer, the most important being:

Age – the risk of prostate cancer increases with age; in men under 50 the risk is very low
Heredity – a man whose father or brother has had prostate cancer is at increased risk of developing it
Ethnicity – African Americans are affected more often, while Asians have a lower risk of prostate cancer
Lifestyle – excess body weight and a high intake of animal-based foods increase the risk of prostate cancer

If the disease is detected at an early stage and is confined to the prostate, it is not an aggressive form and is curable in the vast majority of patients. The progression of prostate cancer that has spread to surrounding structures and organs can now be slowed with new oncology medicines.

Signs and symptoms

Prostate cancer grows slowly, which means several years can pass between the onset of the disease and the appearance of symptoms. Patients in the early stage therefore usually have no complaints. Even when symptoms appear, they are not specific to prostate cancer. The first symptoms are related to urination, because the prostate lies just below the bladder and surrounds the first part of the urethra. Due to the pressure of the cancerous prostate on the urethra, patients have a weaker or interrupted urine stream, strain when urinating, feel that the bladder has not emptied completely and urinate frequently. As the disease progresses, the cancer grows into surrounding organs and tissues, which may cause pain in the perineum or abdomen, blood in the urine and blood in the semen. In advanced disease, metastases can cause bone pain, mainly in the pelvis, spine, ribs and long bones, as well as leg swelling, anaemia, bone fractures caused by metastases (pathological fractures), weight loss and fatigue.

What to expect at the urological examination

At the first examination, in addition to taking a detailed medical history, the urologist performs a digital rectal examination of the prostate, assessing its size, consistency, delineation from surrounding structures and any suspicious nodules. The level of PSA (prostate-specific antigen) in the blood is measured; PSA is produced by the glandular cells of the prostate and is a good biomarker to help diagnose prostate cancer. When cancerous tissue is present in the prostate, PSA levels in the blood are higher, but elevated values can also occur in some non-cancerous conditions, namely benign prostatic enlargement, prostatitis, manipulation of the prostate (cycling, biopsy, catheterisation, prostate massage, cystoscopy) and after sexual intercourse. Before a PSA test, 24 hours without sexual intercourse and cycling is recommended, and PSA should not be measured after any manipulation of the prostate.

Depending on the initial assessment of prostate cancer risk (suspicious digital rectal examination, elevated PSA), the patient is referred either for an mpMRI of the prostate followed by a targeted prostate biopsy, or directly for a transrectal ultrasound-guided prostate biopsy (TRUS). The biopsy confirms or rules out prostate cancer once a pathologist has examined the tissue in detail.

After the histopathological diagnosis of prostate cancer, the patient discusses the nature of the disease and the next steps with the urologist, taking into account the patient's age, other conditions, the stage of the disease, the cancer's risk group and the patient's wishes. If needed, the urologist refers the patient for staging examinations – abdominal CT/chest CT/bone scintigraphy or PSMA PET/CT.

Treatment options

The choice of treatment depends on how aggressive and widespread the disease is, the patient's age, life expectancy and general health. For some patients active surveillance is appropriate, while others need surgery (radical prostatectomy), radiotherapy, hormonal or systemic treatment.

For advanced disease, many modern treatment options are now available that allow an individualised approach.

Prevention comes first

The most effective prevention is regular visits to a urologist and PSA testing. The first urological examination is recommended:

for every man after the age of 50,
after the age of 45 if there are hereditary or ethnic risk factors for prostate cancer
after the age of 40 in men with a confirmed BRCA2 mutation

A healthy lifestyle is also important (more physical activity, weight loss, a diet rich in fruit and vegetables).

Author: asst. Simon Hawlina, MD, FEBU, urologist specialist

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Expert team

Urology clinic

Dejan Galič, MD, FEBU, FECSM

urology specialist

He deals with general urology, especially urological oncology and prostate problems, as well as sexual medicine.

Assoc. Prof. Dr. Simon Hawlina, MD, FEBU

urology specialist

He performs a wide range of urological surgical procedures, focusing on minimally invasive techniques.

dr. Sebastian Jeršinovič, dr. med., FEBU

urology specialist

Specialises in minimally invasive laser endoscopic urology, including laser enucleation of the prostate (ThuFLEP) and laser lithotripsy of kidney stones (URS).

Prof. Dr. Andrej Kmetec, Dr. med.

urology specialist

He deals with the comprehensive treatment of urinary tract problems.

Nuša Naglič, dr. med.

specialist in urology

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Frequently asked questions

Do you have questions? Here you will find answers to the most frequently asked questions related to our services and procedures. If you cannot find the answer, please contact us - we are happy to help you.

The urology clinic treats problems with the urinary tract, prostate, bladder, kidneys, and genitals. These include urination disorders, frequent or painful urination, blood in the urine, lower back pain, and other urological problems.

It is recommended to schedule an appointment for an examination if you have persistent or recurring problems with urination, pain in the lower abdomen or lower back, suspicion of an enlarged prostate, suspicion of inflammation, or unusual discharge. We also recommend regular preventive examinations for men over the age of 50.

The doctor will first discuss your problems and medical history, followed by a clinical examination and, if necessary, an ultrasound, laboratory analysis or uroflow test. Everything is done discreetly and with respect for your privacy.

Of course. Women also face urological problems, such as urinary tract infections, incontinence, or urinary tract stones. In our clinic, we treat both male and female patients of all ages.

Yes, all examinations at the urology clinic are self-pay. This allows for shorter waiting times, flexibility in choosing an appointment, and immediate access to top specialists without a referral.

MD MEDICINE, health and
other services, doo
DŠ: SI59542217
Registration No.: 5748429000

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