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Prostate Cancer

Prostate cancer is the most frequently diagnosed cancer in the Italian male population. According to the report AIOM-AIRTUM I Numeri del Cancro in Italia 2024, more than 40,000 new diagnoses are estimated each year, accounting for about one-fifth of all cancers diagnosed in men. Thanks to advances in early diagnosis and treatments, most patients now have a favorable prognosis.

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What Is Prostate Cancer?

The prostate is an organ of the reproductive system that helps produce sperm. About the size of a walnut, it is placed under the base of the bladder anterior to the rectum. Prostate cancer occurs when cells in the gland grow uncontrollably, leading to the formation of a malignant tumor.

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What Are the Symptoms of Prostate Cancer?

In the early stages, prostate cancer usually proceeds silently, without manifesting any noticeable symptoms. However, as the disease progresses, the following symptoms may occur:

  • increased frequency of urination, especially during the night;
  • difficulty initiating urination;
  • reduction in the strength of urinary flow;
  • feeling of incomplete emptying of the bladder;
  • presence of blood in the urine or semen;
  • erectile dysfunction.

In more advanced forms, bone pain may appear, especially in the spine, pelvis or ribs, involuntary weight loss and other symptoms related to the spread of the disease.

Risk factors for prostate cancer

Several factors can increase your risk of developing prostate cancer, including:

  • Age – the risk increases progressively after the age of 50.
  • Family history – having a father, sibling or other first-degree relatives with prostate cancer increases the individual risk.
  • Genetic predisposition – some inherited mutations, including those in the BRCA1 and especially BRCA2 genes, are associated with an increased risk of developing the disease.
  • Overweight and obesity – can be associated with more aggressive forms of cancer.
  • Lifestyle – Unbalanced diet, sedentary lifestyle and smoking can contribute to worsening the overall risk of the disease.

How to reduce the risk of prostate cancer

There are no strategies that can completely prevent prostate cancer. However, adopting a healthy lifestyle can help reduce the overall risk of the disease and improve overall health. It is recommended to:

  • maintain an adequate body weight;
  • practice regular physical activity;
  • follow a balanced diet rich in fruit, vegetables, whole grains and legumes;
  • limit alcohol consumption;
  • avoid cigarette smoking.

Men with a family history or genetic predisposition should discuss with their doctor whether they should start personalized urological check-ups.

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How Do You Diagnose Prostate Cancer?

Currently, in Italy there is no organized screening program for the entire male population. The decision to perform periodic check-ups must be evaluated together with your doctor or urologist specialist, considering age, family history and other risk factors.

Tools used for early detection may include:

  • prostate-specific antigen (PSA) assay by blood test;
  • digital rectal examination (DRE);
  • multiparametric magnetic resonance imaging of the prostate (mpMRI) in the cases indicated.

The presence of alterations does not necessarily equate to a diagnosis of cancer, but may require further specialist investigation.

In people with a family history of prostate cancer or other inherited malignancies, genetic counseling can help identify any mutations associated with an increased risk of the disease. The results can be useful for personalizing the surveillance program and, when necessary, guiding treatment choices.

Prostate biopsy

If you have an elevated PSA, abnormalities on rectal examination, or suspicious findings on multiparametric MRI, your doctor may recommend a prostate biopsy. The biopsy is the definitive examination to confirm or exclude the presence of cancer cells. Today, when possible, it is carried out by integrating MRI images with ultrasound images (fusion biopsy), increasing diagnostic accuracy.

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How Do You Treat Prostate Cancer?

But the good news is that prostate cancer is highly treatable when caught early. In addition, new techniques are shortening the treatment time and minimizing side effects. But it remains important to know your risks, know the symptoms, get regular screenings, and understand your treatment options.

Prostate cancer treatments

Today there are many treatments for localized prostate cancer. The type of treatment you receive will depend on your risk level, your age, and any other health problems. Your doctor will take time to clearly explain your cancer, your options for treatment, and possible side effects.

Active surveillance

In low-risk and slow-growing tumors, active surveillance may be proposed, a path that includes periodic checks by PSA, specialist visits, magnetic resonance imaging and any control biopsies. The goal is to closely monitor the disease and intervene only if signs of progression emerge, avoiding unnecessary treatments and related side effects.

Radiation treatment

Radiotherapy is one of the most common treatments, alongside surgery, for eliminating residual cancer cells and preventing the spread of the disease. By using high-intensity energy beams, radiotherapy destroys cancer cells.

Modern radiotherapy techniques allow the tumor to be treated with high precision, limiting the exposure of surrounding healthy tissues. In selected cases, hypofractionated treatment schemes can be used, which allow to reduce the number of sessions compared to traditional protocols.

Nerve-sparing prostatectomy

The most frequent surgical procedure to treat prostate cancer is radical prostatectomy, an operation to remove the prostate gland and some tissue around it. The surgeons who treat prostate cancer are experts at using minimally invasive robotic surgery to remove the cancer, while safeguarding the surrounding nerves that govern urinary and sexual function.

Hormone therapy

This works by blocking testosterone production or stopping testosterone from interacting with the tumor cells. This reduces the tumor size or slows its growth. While hormone therapy may help control prostate cancer, it does not cure it.

Immunotherapy

In selected cases, especially in advanced forms of the disease with specific biological characteristics, innovative treatments such as immunotherapy and targeted therapies may be considered. The indication is evaluated individually by the multidisciplinary oncology team.

Laser focal therapy

Focal laser therapy is a minimally invasive treatment that uses laser energy to destroy tumor tissue in a targeted manner, preserving as much of the healthy portion of the prostate as possible.

The procedure is planned on the basis of diagnostic tests and images obtained with multiparametric magnetic resonance imaging, which allow the area to be treated to be precisely identified. Through thin laser fibers introduced into the prostate, the heat generated causes the ablation of the selected tumor tissue.

The goal of focal therapy is to treat the tumor by limiting the impact on surrounding structures and reducing the risk of some side effects associated with more extensive treatments. Suitability for the procedure is assessed on a case-by-case basis by the specialist.

Focal Therapy by Irreversible Electroporation (IRE)

Focal therapy by irreversible electroporation (IRE), also known as NanoKnife, is a minimally invasive technical treatment used in selected cases of prostate cancer. Through the insertion of electrode needles in the area to be treated, electrical impulses are delivered that determine the destruction of cancer cells while preserving, as far as possible, the surrounding anatomical structures.

Unlike other abrasive techniques, IRE does not rely on the use of thermal energy. This approach can help reduce the risk of damage to nerves, blood vessels, and other nearby structures, with potential benefits on maintaining urinary and sexual function. The procedure is indicated in patients carefully selected on the basis of the characteristics of the tumor and the evaluations made by the specialist. Although the available results are promising, studies are still underway to fully define its oncological efficacy in the long term.

Clinical trials

Research and clinical trials lead to better care for cancer patients. At any time, UPMC Hillman Cancer Centers worldwide are involved in hundreds of clinical trials offering the latest, most innovative treatments. These studies examine new treatments, devices, and medicines for a variety of cancer types and conditions.

Different treatments have different side effects. Your doctor will talk to you about your options based on the level of disease and your overall health.

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Reviewed October 2026.