Prostate cancer: a revolution in treatment and diagnosis – it is crucial to get checked from the age of 50

In Italia, prostate cancer – for which World Prostate Cancer Day is observed on 11 June – is now the most commonly diagnosed cancer among men, with around 40,000 new cases each year. This figure might seem alarming if not viewed alongside another extremely significant statistic: the five-year survival rate following diagnosis now exceeds 90%. This is concrete evidence of how research, technological innovation and advances in treatment have transformed the natural history of this disease. Over the last twenty years, we have witnessed a profound transformation in the way prostate cancer is detected and treated. Today, the aim is not only to treat the patient, but to do so whilst preserving their quality of life as much as possible.

The first breakthrough has come in the field of diagnosis; indeed, the introduction of multiparametric magnetic resonance imaging has made it possible to identify suspicious lesions with greater accuracy and to better select those patients who genuinely require further investigation. This means that biopsies, too, thanks to the fusion of ultrasound and MRI images, can now be performed in a much more targeted manner, reducing the need for unnecessary procedures and improving the ability to identify the most clinically significant tumours.

At the same time, research has made significant strides in understanding the biological characteristics of the disease. Genomic analysis now makes it possible to distinguish, with increasing accuracy, between the more aggressive forms and those that progress more slowly. This means that many men can be offered active surveillance programmes, thereby avoiding immediate interventions or treatments when they are not actually necessary. This is an important cultural shift, as modern medicine aims not to treat more patients, but to treat them better, reserving therapies for those who will derive a tangible benefit from them.

The advent of new hormonal therapies has contributed to extraordinary therapeutic progress: it has significantly altered the prognosis of the disease, enabling longer survival even in advanced or metastatic forms. At the same time, precision medicine is opening up possibilities that were unthinkable just a few years ago: in the presence of specific genetic alterations, it is now possible to use targeted drugs that act selectively on the tumour’s biological vulnerabilities, making treatments increasingly personalised.

The same trend can be seen in the operating theatre. Robot-assisted surgery has introduced levels of precision that were previously difficult to achieve, thanks to a three-dimensional view of the surgical field and instruments capable of extremely precise movements. This allows the surgeon to operate more selectively, preserving as much as possible the structures responsible for urinary continence and sexual function. Whereas in the past the main objective was to remove the tumour, today the challenge is to do so whilst maintaining the best possible quality of life for the patient.