THEn Italy the prostate cancer continues to be the most widespread silent enemy among men. The numbers speak clearly: according to theHigher Institute of Healthin 2024, over 40 thousand new diagnoses are estimated, while approximately 7 thousand men die every year from this disease. Yet, when intercepted early, the Prostate cancer is often curable with excellent chances of recovery. What makes the difference is not only increasingly refined diagnostic technologies, but also – and above all – awareness. Two specialists talk about itIRCCS San Raffaele Hospital: Andrea SaloniaFull Professor of Urology at Vita-Salute San Raffaele UniversityAnd Edoardo Pozziurologist of the Urology Operating Unit.
Why talking about it today is still so important
The real risk, specialists explain, is not only the disease itself, but the delay in diagnosis. “The silence and embarrassment lead many men to postpone checks, even when it would be the right time to do them”, they underline. And this despite the clinical reality being much more encouraging than one imagines: a tumor diagnosed at an early stage has very high cure rates. Addressing the topic without hesitation is not a sign of fragility, but an act of responsibility towards oneself.
Age, familiarity and lifestyle: who is most at risk
Age remains the main risk factor. Before the age of 40, prostate cancer is rare, but the incidence increases significantly after the age of 50, so much so that approximately two out of three diagnoses concern men over 65. Family history weighs heavily: having an affected father or brother doubles the risk, which can increase up to six times if there are more than one cases in the family and diagnosed at an early age.
Then there are genetic mutations, such as BRCA1 And BRCA2and factors related to lifestyle: smoking, sedentary lifestyle, obesity and a diet rich in saturated fats. «These are modifiable elements – they explain – on which we can intervene even when we are young».
When to start checks
For men without risk factors, a first PSA measurement around age 50 is considered appropriate. Those with significant family history or genetic mutations should anticipate around 40 years. Always with a key principle: the decision must be shared with the specialist, based on the individual risk profile. In this context, the launch in Lombardy of the first organized screening program for prostate cancer represents a historic step in male prevention.
PSA: imperfect but irreplaceable tool
PSA remains the point of reference in early diagnosis. It is not a test “for cancer”, but for the prostate: it can increase even in the presence of benign conditions. However, there are no alternatives that can replace it in the initial path. It is the trend of the PSA over time, together with the specialist visit and the patient’s clinical history, that guides subsequent decisions.
From “intelligent PSA” to multiparametric resonance
The innovations of recent years make diagnosis more precise and personalized. The so-called PSA reflex – or “intelligent PSA” – helps to better distinguish between benign and suspicious pathologies, reducing false positives. This is accompanied by multiparametric (and, in some cases, biparametric) magnetic resonance imaging, which accurately identifies areas at risk and allows targeted biopsies only when truly necessary. The result? Fewer unnecessary invasive tests and more correct diagnoses.
Overcoming the taboo of urological examination
Embarrassment remains one of the main obstacles. Digital rectal examination is often perceived as invasive, but urologists explain that it is a quick and clinically useful test. “A brief discomfort can prevent a serious pathology,” they recall. And correct information is the first step to breaking down the wall of modesty.
Symptoms: when they appear and why not expect them
Prostate cancer is often silent in its early stages. Symptoms – urinary difficulty, bone pain, tiredness, weight loss – tend to appear later. Precisely for this reason prevention is decisive: the absence of disorders does not mean the absence of disease.
Lifestyle: small gestures, big impact
There is no “absolute” prevention, but some choices help. Diet rich in fruit, vegetables and whole grains, less red meat and saturated fats, regular physical activity and weight under control. Even 150 minutes a week of moderate movement is enough. These are habits that reduce the risk of aggressive forms and improve the response to therapies.
After the diagnosis: sexuality and quality of life
After surgery, such as radical prostatectomy, the quality of life may change, especially for continence and erection. But the improvements are progressive and often significant. Ejaculation is no longer present, but the pleasure of orgasm remains. Pre-operative information, medical support and open communication with your partner are fundamental.
Breaking the silence on men’s health
«The urologist is the male’s doctor», the specialists remind us. To change the culture of silence, public campaigns, a strong alliance with family doctors and constant media commitment are needed. Talking about prevention does not take anything away from virility, but restores self-respect.
Looking to the future
Artificial intelligence applied to radiology, molecular diagnostics, new drugs and innovative radiopharmaceuticals are changing the scenario of prostate cancer, even in advanced forms. The prospects are promising: more precision, targeted therapies and increasingly longer survival. Because the real revolution today is simple: inform yourself, check yourself and don’t put it off. Talking about the prostate is talking about life.