Prof. Pierluigi Bove discusses the importance of lifestyle for prostate health: prevention, nutrition, and early diagnosis
When we talk about prostate cancer, people often ask whether—and how much—our everyday habits can really make a difference. Prevention now has a central role in modern medicine, and interest in lifestyle is no longer only a cultural topic: it is a genuine clinical need. Still, we have to separate what we would like to be true from what we can actually prove; the advice we can give with common sense from what is supported by solid evidence.
Lifestyle and prostate cancer: the line between belief and science
As a urologist, I am often asked whether a healthy diet or regular physical activity can truly prevent prostate cancer. The honest answer is that, at present, we do not have absolute scientific certainty that allows us to claim a direct link between a healthy lifestyle and a reduced incidence of this tumor. Some observational studies have suggested interesting correlations, especially in relation to metabolic syndrome, but these are signals rather than definitive proof.
What we do know is that conditions such as hypertension, type 2 diabetes mellitus, and obesity are associated with a state of chronic, systemic inflammation. This kind of inflammation—now recognized as a co-factor in many degenerative and oncological diseases—may represent fertile ground for the onset or worsening of cancers, including prostate carcinoma. In this sense, a lifestyle that counters these pathological conditions can play an indirect, yet meaningful role in preserving the body’s overall balance.
So we should not fall into the illusion of “mechanical” prevention, where following a nutrition plan is enough to avoid disease. The complexity of human biology—and especially the genetic component—makes that view too simplistic. But adopting healthy habits still makes sense: not as a guarantee, but as a favorable condition.
The weight of genetics and the role of the environment
One of the most fascinating—and often underestimated—areas of evidence concerns the relationship between genetics, environment, and cancer incidence. We know the prostate is an organ strongly influenced by hormones and by epigenetic factors, meaning changes that do not alter DNA but regulate its expression. This is where the environment we live in comes into play: lifestyle, dietary habits, exposure to substances, pollution, and chronic stress.
A fact I often mention with interest is the geographical distribution of prostate cancer. In Asian countries such as Japan or China, the incidence of this cancer has historically been much lower than in the United States or Western Europe. Yet when an Asian family moves to a Western country, even within the first generation the risk tends to align with that of the local population. This suggests that environmental factors, in a broad sense, carry more weight than many people assume.
Of course, this does not mean the environment can completely override genetic predisposition. But it clearly indicates there is a subtle interaction between the two levels, and it is precisely at that intersection that we can—at least in part—act. Not to eliminate risk, but to influence its trajectory.
Nutrition: observations and reasonable recommendations
A balanced diet inspired by the Mediterranean tradition remains sound advice. We are talking about a nutritional model that favors whole grains, vegetables, legumes, fish, fresh fruit, and extra-virgin olive oil, with moderate consumption of red meat and saturated fats. The goal is not to prescribe a rigid diet, but to suggest a direction.
Some studies associate higher intake of animal fats and refined carbohydrates with an increased incidence of cancers, including prostate cancer. However, none of these data can be treated as absolute truth. They are better understood as guidance. In urology, this approach allows us to support patients with balance, avoiding both a fatalistic stance (“it’s all genetic anyway”) and an extreme prescriptive approach that can create anxiety rather than benefit.
It is important to remember that diet alone is neither a cure nor infallible prevention. But in a complex system like ours, anything that reduces chronic inflammation, helps regulate metabolism, and supports the immune system can be an ally. Not a final weapon, but a valuable support.
Family history, age, and the importance of early diagnosis
Beyond lifestyle, two factors remain central in prostate cancer risk: family history and age. The scientific literature is clear: having a first-degree relative (father, brother) with prostate cancer significantly increases the likelihood of developing the same disease. This correlation is not deterministic, but it should be taken seriously—especially when deciding the right timing for evaluation and follow-up.
Age is another key factor. The vast majority of prostate cancers are diagnosed after age 60, but that does not mean there are no signs to catch earlier. On the contrary, we now have diagnostic tools that are far more accurate than in the past, allowing us to identify potentially aggressive tumors even at an early stage.
From this perspective, the PSA (prostate-specific antigen) test remains a useful indicator, though it has limitations. For this reason, in advanced clinical practice it is often combined with multiparametric MRI, an exam that can map the inside of the prostate with great precision and highlight any suspicious lesions. If needed, the next step is a targeted biopsy guided by the MRI findings.
This approach has profoundly changed our ability to personalize diagnosis and has allowed us to move from a quantity-based model (number of biopsies) to a quality-based one (diagnostic accuracy). It is a meaningful step forward: it reduces the risk of overdiagnosis and allows intervention only when it is truly necessary.
Targeted treatments and an integrated view: robotic surgery, radiotherapy, focal therapies
Once the diagnosis is confirmed, the next phase is choosing the most appropriate treatment. This is where the concept of “made-to-measure medicine” becomes particularly concrete. Prostate cancer is not a uniform disease: it can be indolent and very slow-growing, or it can present in aggressive forms that require timely treatment. It is essential to distinguish case by case.
Prof. Bove has consistently promoted an integrated approach in which robotic surgery is one of the most advanced options. Thanks to its minimally invasive nature and the millimetric precision of the surgical gesture, robotic surgery can remove the tumor while preserving—when possible—sexual and urinary function. But it is not the only path.
Radiotherapy, now delivered with highly sophisticated technologies, is a valid alternative for many patients, especially at older ages or in the presence of comorbidities. And in selected cases, we can consider so-called focal therapies, which treat only the diseased portion of the prostate while leaving the healthy gland intact. This approach is not suitable for everyone, but it opens new horizons in the direction of maximum functional preservation.
In this context, the future will not be only technological, but also cultural: it means promoting a medicine that takes into account the patient’s quality of life, priorities, and values. A medicine that knows how to choose, not only how to act.
Artificial intelligence in the service of the patient: real scenarios, not science fiction
In recent years there has been a lot of talk about the impact of artificial intelligence in medicine. But beyond media excitement, there are already practical applications that improve our ability to diagnose and plan personalized oncology treatments. Some algorithms can analyze large amounts of clinical data, diagnostic images, and genetic information, producing reliable predictive models.
In urology, this can mean estimating more accurately the probability that a suspicious lesion is truly malignant. It can also mean simulating how a tumor may behave over time if left untreated, helping physicians and patients evaluate options with greater awareness.
Prof. Bove follows the evolution of these tools closely and integrates their potential with daily clinical experience. The goal is not to delegate decisions to an algorithm, but to use computational power to support clinical reasoning—enriching it, not replacing it. In this way, AI becomes an automated second opinion, especially useful in borderline cases.
Not everything depends on us, but much is within our hands
Prostate health, like every aspect of our body, is the result of a dynamic balance between genetics, environment, and personal choices. No serious physician can promise absolute certainty. But what we can do today is rely on increasingly refined tools to understand, anticipate, and intervene.
The message Prof. Pierluigi Bove shares with his patients is clear: early diagnosis remains the most powerful tool, but it should be part of a medicine that sees the person. A shared pathway built on listening, understanding, and awareness.
References:
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