The prostate unit organizational model, from imaging to management: State of art

Background and aim: Prostate cancer represents one of the most common malignancies in men and a leading cause of cancer-related morbidity and mortality worldwide. In recent years, improvements in diagnostic imaging, biopsy techniques and therapeutic strategies have contributed to earlier detection and better risk stratification. At the same time, the growing complexity of prostate cancer management requires integrated and patient-centred organizational models. This narrative review aims to summarize the current evidence on the role of multiparametric magnetic resonance imaging (mpMRI) in prostate cancer diagnosis, active surveillance and treatment planning, and to describe the Prostate Unit as an innovative multidisciplinary organizational model starting from imaging. Methods: We conducted a narrative review of the literature using PubMed and Google Scholar, primarily focusing on publications from 2010 onward. Inclusion criteria included international guidelines and consensus documents, with a focus on mpMRI, the Prostate Imaging Reporting and Data System (PI-RADS), and MRI-directed biopsy. Furthermore, we analyzed the organizational framework and clinical governance principles of the Prostate Unit model. Results: Multiparametric MRI has become the reference imaging modality for the detection and local staging of clinically significant prostate cancer, allowing improved patient selection for biopsy and treatment. MRI-targeted biopsy increases diagnostic accuracy and reduces overdiagnosis compared with systematic transrectal ultrasound-guided biopsy. MpMRI also plays a central role in active surveillance protocols and therapeutic planning. The Prostate Unit model, based on multidisciplinary collaboration and integration of transversal services, enables coordinated patient management, optimization of resources, and improved appropriateness of care, with imaging representing the entry point of the diagnostic-therapeutic pathway. Conclusions: The integration of advanced imaging techniques with a structured multidisciplinary organizational model is essential for contemporary prostate cancer management. The Prostate Unit represents an effective strategy to translate precision medicine into clinical practice, improving quality of care, patient outcomes and healthcare system efficiency.