Prostate cancer prevention is painless
Research at the Jessenius Faculty of Medicine of Comenius University in Martin (JFM CU) has long been conducted at an international level. This is also reflected in a recent award received by a team of experts from Martin at a prestigious symposium in New York held under the auspices of the Mount Sinai Institute. We spoke with Róbert Dušenka, Assistant Professor at the Urology Clinic of JFM CU and Martin University Hospital (UNM), about the importance of genetic research in the diagnosis of prostate cancer and the persistent barriers to prevention.
Your team received significant international recognition for its prostate cancer research. What do you think of this achievement after some time has passed?
For our team, this award is above all a confirmation that the research carried out in Martin meets global standards. It is the result of long-term, systematic work across several departments - the Urology Clinic of JFM CU, Martin University Hospital, and the Institute of Medical Biochemistry of JFM CU.
At the symposium, we presented research focused on analysing genetic variations in selected genes and their impact on the risk of developing prostate cancer. Our aim is to identify new genetic markers that will enable earlier and more precise risk stratification in patients. This research is not a one-off outcome, but the culmination of more than a decade of continuous work.
A key challenge, however, remains the translation of these findings into clinical practice so that they can bring real benefits to patients.
Moving from research to the patient - prevention remains a key factor. Why do men still pay so little attention to it?
The most significant barriers are fear of the unknown and a certain degree of embarrassment. Men often seek medical attention only once they experience symptoms. The difficulty with prostate cancer, however, is that in its early stages it is asymptomatic.
From a urologist’s perspective, it is crucial to detect the disease at this stage, when the likelihood of successful treatment is very high. Despite this, we still encounter misconceptions about the pain or time demands of the examination. In reality, it is a short procedure, lasting approximately 15 minutes, and it is not painful.
What does a preventive examination involve?
The examination begins by studying the medical history, focusing on risk factors and any symptoms. This is followed by a digital rectal examination of the prostate, which is often perceived as the greatest barrier. Although it may be slightly uncomfortable, patients generally rate it as well tolerated.
The examination also includes an ultrasound assessment of the kidneys and measurement of the prostate-specific antigen (PSA) level in the blood. PSA is the most widely used biomarker in prostate cancer screening. On its own, it is not diagnostically definitive; however, in combination with a clinical examination it allows for a high degree of diagnostic accuracy.
How do you proceed in the case of a suspicious finding?
In cases of suspected disease, we indicate a prostate biopsy, which remains the diagnostic standard for definitively confirming or ruling out malignancy. The procedure is performed under local anaesthesia and is well tolerated by most patients.
Further treatment depends on the risk stratification of the disease. In cases of localised cancer, we achieve very high success rates, which again underscores the importance of early diagnosis.
Are there clear recommendations on when men should undergo preventive screening?
As a standard, we recommend starting screening after the age of 50. For men with a positive family history - that is, if prostate cancer has occurred in a father or brother - we recommend starting ten years earlier, at around the age of 40.
If the findings are negative, the examination is usually repeated at three-year intervals. It is important not to wait for symptoms to develop, as these may indicate a more advanced stage of the disease.
In addition to your clinical and research work, you are also a teacher. What approach do you try to pass on to medical students?
I try to guide them towards a broader understanding of medicine and of the medical profession as a whole. I do not see urology in isolation, but as part of a comprehensive approach to the patient.
I emphasise that real responsibility comes only after graduation, when they begin making decisions about patients’ health and lives. This is precisely what makes medicine demanding, but also highly meaningful.
Can a teaching approach influence the choice of future specialisation?
I am convinced that it can. The way a field is presented plays an important role. We are pleased when students change their perception of urology after completing their placements and begin to consider it as a future specialisation.
Direct contact with clinical practice is irreplaceable. As I tell students, experience is key in medicine. Without it, knowledge remains theoretical.
Eva Kopecká