Prostate screening, Lombardy forerunner: the challenge is to take it to the whole of Italia

Lombardy has paved the way. With the first organised and free screening programme for prostate cancer, the region becomes a test bed for a possible national extension in the Essential Levels of Care. A step that, if confirmed, would mark a paradigm shift in male cancer prevention.

The model adopted includes a structured pathway: online filling in of a risk questionnaire, Psa test as the first level, multi-parametric MRI in suspected cases and targeted biopsy only when necessary. By December 2025, some 26,000 completed questionnaires had been registered, with more than 20,000 subjects eligible for the Psa test. This approach overcomes the 'opportunistic' screening that is common in Italy today, which is often disorganised and inappropriate.

'It is the first region that has started organised screening for prostate cancer,' explains the president of the Italian Society of Urology (Siu), Giuseppe Carrieri. 'Other regions are moving, but until it is included in the Lea it will remain limited to a few regions.

The topic is also relevant from an epidemiological point of view. Prostate cancer is in fact the most common cancer among men, with over 40 thousand new cases every year - up to 60 thousand according to clinical estimates - and about 6 thousand deaths. Numbers that place it among the major public health challenges. Despite this, male prevention lags behind other areas. "Men do fewer check-ups and arrive later at diagnosis,' Carrieri observes. 'There is a cultural resistance and less attention to prevention that still weighs heavily'.

Also affecting this is the inefficiency of the current system. Opportunistic screening costs the National Health Service about 180 million euros a year, without guaranteeing appropriateness or uniformity. 'It is a non-coded screening,' emphasises the urologist. - Unnecessary examinations are carried out and patients who would really need them are lost'. Among other things, two members of the Siu Board of Directors - Professor Andrea Salonia, a specialist in Urology and in Endocrinology and Exchange Diseases, and Professor Bernardo Rocco, director of urology at the Gemelli polyclinic and a member of the Endourology, Laparoscopy and Robotics Siu Section - were part of the Region's Technical-Scientific Committee in charge of drawing up the screening programme for the Lombardy Region.