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Prostate cancer is the most common malignancy in the male population of the Western world. However, modern oncology has changed the narrative: diagnosis no longer necessarily implies immediate surgical intervention. The so-called “calm strategy”, active monitoring and the approach of a multidisciplinary team are today essential tools that ensure not only survival, but also the quality of life of the man.

The PSA is a test that all men know. But is it always reliable? When should the test begin?

The PSA is a particularly useful pre-symptomatic screening tool, as long as it is interpreted correctly. An elevated value does not necessarily mean cancer, as it can be due to inflammation or benign prostatic hyperplasia.

Traditionally, screening is recommended after age 50. However, as the age of diagnosis is decreasing, modern guidelines recommend: 

• at 45 years:a baseline for all men.

• before 45 years: If there is a family history. 

It is worth noting that a PSA value of “4”, often considered the upper limit of normal, for a 45-year-old man may not be normal and require further investigation.

Many patients request immediate surgery. What is active surveillance and when is it recommended?

Prostate cancer often progresses very slowly and, in many cases, especially in older men or in very early stages, the disease can be clinically “innocent”. 

Active surveillance means that we do not proceed immediately with surgical or other invasive treatment, but we closely monitor the biological behavior of the tumor with regular tests. In this way, we avoid unnecessary interventions, which may be accompanied by undesirable effects, such as:

• urinary incontinence

• erectile dysfunction

The goal is to intervene only when and if the disease shows signs of aggression, preserving the patient’s quality of life for as long as possible.

What role does the interdisciplinary team play in the correct treatment decision?

Multidisciplinary treatment is crucial in prostate cancer, as the first treatment
conduction. Although this is a more limited recording, it can highlight significant rhythm disturbances, such as atrial fibrillation. In cases where the recording on the wrist is not sufficiently clear and sharp, repositioning the device higher on the wrist or rarely on the ankle may improve the quality of the signal, facilitating medical evaluation. 

2. Photoplethysmography (PPG – the “green light”)

The sensor on the back of the device emits green light, which penetrates the skin and detects changes in blood flow in the capillaries. This technology, known as photoplethysmography, allows for continuous monitoring: 

• the frequency and regularity of heartbeats,

• the burden of arrhythmias (such as atrial fibrillation episodes),

• indicators associated with increased stress or disturbances in the quality of sleep.

Telemedicine and remote areas

One ​​of the most important advantages of smartwatches is their contribution to telemedicine and the monitoring of patients living in island or remote areas. The ability to send data in real time allows for early symptom assessment and, in some cases, reduces the need for Holter monitoring, as the device provides continuous recording on a 24-hour basis.

The Limitations of Technology

Despite progress, there are clear limits to the use of wearables: 

• Blood pressure: Measuring blood pressure via a smartwatch cannot currently replace the reliability of conventional blood pressure monitor with cuff. For the correct diagnosis and regulation of hypertension, the classic method remains the appropriate one. 

• Psychological burden: Constant monitoring and excessive preoccupation with measurements may cause stress in some
  users. The technology must operate in a supportive and discreet manner, alerting only when there is a substantial indication that requires medical evaluation. 

In conclusion, the smartwatch is a valuable complementary tool in cardiac monitoring. It does not replace medical practice nor does it function as an autonomous “diagnostician”. Its rational use, combined with the clinical assessment of the treating physician, is what maximizes the benefit for the patient and enhances prevention.