Prostate cancer (PCa) is one of the most prevalent malignancies in men, characterized by high clinical and molecular heterogeneity. Despite the widespread use of prostate-specific antigen (PSA) for diagnosis and monitoring, its limited specificity and sensitivity necessitate the development of more accurate biomarkers. This review provides a comprehensive overview of current and emerging diagnostic, prognostic, and predictive biomarkers in PCa, highlighting their clinical applications and future perspectives. PSA, though historically central in PCa screening, lacks tumor specificity, often leading to unnecessary biopsies or missed aggressive cancers. Recent blood-based biomarkers, such as the Prostate Health Index (PHI) and 4Kscore, improve specificity by integrating PSA isoforms or kallikrein protein levels with clinical parameters. Urine-based biomarkers like PCA3 and SelectMDx further enhance diagnostic precision, particularly in distinguishing high-grade tumors, and show potential in active surveillance settings. Prognostic markers such as Bcl-2, Ki-67, and EZH2, alongside genetic alterations like MCM7 and 8q gain, help stratify patients by tumor aggressiveness and risk of recurrence. Liquid biopsies, including circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs), offer non-invasive alternatives for molecular profiling, especially in metastatic castration-resistant PCa (mCRPC), and can identify actionable alterations such as BRCA1/2 or ATM mutations. Emerging technologies such as machine learning and single-cell omics are reshaping biomarker discovery. Artificial intelligence-driven models, like the replication stress signature (RSS), show promise in predicting relapse and therapeutic response. Single-cell RNA sequencing and spatial transcriptomics have deepened our understanding of PCa heterogeneity, tumour microenvironment, and resistance mechanisms. Furthermore, novel biomarkers, including exosome RNAs and immune-related markers (PD-L1, SOX2, TcellinfGEP), offer insights into tumour progression and immunotherapeutic potential. The urinary and gut microbiomes are also being explored for their diagnostic and prognostic roles in PCa. In conclusion, integrating advanced molecular tools and biomarker-guided platforms into clinical practice can significantly enhance early detection, personalized treatment, and monitoring in prostate cancer, paving the way for precision oncology.

Bladder cancer is the ninth most common malignancy worldwide, with two clinically distinct forms: non-muscle-invasive disease, characterized by high recurrence and excellent long-term survival, and muscle-invasive disease, associated with poorer outcomes. Current surveillance-cystoscopy and urine cytology-offers high specificity but is invasive, costly, and insensitive to low-grade tumors, underscoring the need for reliable, non-invasive biomarkers. Liquid biopsy approaches in urine and blood have demonstrated promise for real-time assessment of tumor burden, molecular heterogeneity, and early recurrence. Circulating tumor DNA (ctDNA) assays detect tumor-derived genetic and epigenetic alterations, enabling dynamic monitoring of minimal residual disease and treatment response. Methylation-based tests and CpG-targeted sequencing in urine achieve high diagnostic accuracy, potentially reducing dependence on cystoscopy. Molecular classification of bladder tumors into luminal and basal subtypes has refined therapeutic strategies: FGFR inhibitors for luminal-papillary tumors, EGFR-targeted and chemotherapy approaches for basal/squamous cases, and immune-checkpoint inhibitors guided by immune-infiltration profiles. Integration of artificial intelligence with multi-omic liquid biopsy data further enhances predictive modeling for recurrence, treatment response, and minimal residual disease detection. Despite these advances, clinical implementation faces challenges including pre-analytical variability, lack of standardized assays, limited prospective validation, and unclear cost-effectiveness. Harmonized protocols, large multicenter trials, and health-economic evaluations are essential to translate liquid biopsy technologies into routine practice. Future integration with advanced imaging, tissue biopsy, and digital pathology-supported by multidisciplinary collaboration and formal guideline endorsement-holds the potential to personalize bladder cancer management, reduce invasive procedures, and improve patient outcomes.

MicroRNAs (miRNAs) are noncoding, single-stranded RNAs molecules modulating gene expression thanks to their ability to bind mRNAs. Indeed, they regulate key processes for the proper functioning of the organism and affect the course of human pathologies. Altered expression of individual miRNAs has been shown in most human cancers, endowed with oncogenic or suppressor potential. Additionally, miRNAs have shown a promising potential as cancer markers. Not only miRNAs are present in various body fluids, such as serum and plasma, they also have high biological stability of miRNAs that in turn facilitates their detection. For these reasons, the use of miRNAs detection as non-invasive prognostic and predictive biomarkers in cancer provides new perspectives and strategies for personalized medicine and cancer therapy. This review summarizes the current knowledge supporting the utility of miRNAs as novel early diagnostic and prognostic tool, with a special focus on the effectiveness of miRNAs of the liquid biopsies in the diagnosis of urogenital cancers. In conclusion, we rightly state that circulating miRNAs and therefore liquid biopsy have the potential to revolutionize the diagnosis, monitoring and even treatment of urological tumors, entering clinical practice as a more accurate, less invasive and more suitable diagnostic tool for patient follow-up compared to current methodologies. With the progress of scientific research and the implementation of advanced technologies that also exploit artificial intelligence, the future of oncological diagnosis, especially for urological tumors, could be increasingly oriented towards less invasive approaches and based on precision medicine, tailored for the specific patient.

Male infertility is a prevalent global health issue, with urological disorders representing some of the most common and correctable causes. Key conditions such as varicocele, obstructive azoospermia, erectile dysfunction and Peyronie’s disease impair fertility through distinct pathophysiological mechanisms, including disrupted spermatogenesis, reproductive tract obstruction and failed sperm delivery. The effective management of these conditions hinges on a systematic diagnostic evaluation, which integrates clinical history, physical examination, semen analysis and specialized imaging. Modern management follows a logical progression, beginning with foundational lifestyle modifications, advancing to targeted medical or surgical interventions, and culminating, when necessary, in assisted reproductive technologies. Treatment strategies are therefore highly targeted, ranging from medical management and surgical correction—such as varicocelectomy or microsurgical reconstruction—to sperm retrieval techniques. Furthermore, evidence-based lifestyle modifications and a multidisciplinary clinical approach are fundamental to optimizing reproductive outcomes for affected couples. A comprehensive understanding of these urological etiologies is therefore essential for guiding appropriate intervention and improving the prospects of achieving pregnancy.

Erectile dysfunction (ED) is a common multifactorial condition with significant physical, psychological and relational consequences. While historically associated with aging, its rising prevalence among younger men underscores the need for updated diagnostic and therapeutic frameworks. This narrative review synthesizes contemporary evidence on the pathophysiology, diagnostic workup and management of ED, with emphasis on guideline-directed care and emerging treatment modalities. A comprehensive literature search was conducted, with evidence synthesized from key clinical guidelines, landmark trials and recent peer-reviewed studies. Lifestyle optimization remains the foundational step, followed by first-line pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5is), which demonstrate high efficacy and safety across diverse patient populations. For patients with inadequate PDE5is response, second-line options include alprostadil (intracavernosal, with approximately 70% success rates or intraurethral), vacuum erection devices and penile prosthesis surgery, with patient and partner satisfaction exceeding 95% for the latter when performed in experienced centers. Psychosexual therapy is an integral adjunct, particularly in psychogenic or mixed etiologies. Regenerative approaches such as low-intensity extracorporeal shockwave therapy (Li-SWT) and platelet-rich plasma (PRP) injections are under investigation; current evidence supports their use only in experimental settings due to limited long-term data. A multidisciplinary, individualized strategy—incorporating pharmacologic, surgical and psychosocial interventions—remains the cornerstone of modern ED management. This review critically distinguishes well-established evidence from ongoing clinical debates and translates findings into practical guidance for daily practice. Ongoing technological advances may further refine diagnostic accuracy and treatment personalization, but high-quality studies are needed to establish the role of regenerative and digital tools.

Chronic epididymitis and orchitis represent significant yet frequently under-recognized contributors to male infertility, particularly among men of reproductive age. These conditions arise from persistent inflammatory or immunological processes affecting the epididymis and testis, leading to impaired spermatogenesis, altered sperm maturation and possible obstruction of the male reproductive tract. Infectious aetiologies, especially those linked to sexually transmitted pathogens and uropathogens, remain predominant; however, non-infectious mechanisms, including autoimmune activation, post-vasectomy changes and idiopathic inflammation, also play critical roles. The persistent inflammatory milieu induces cytokine release, oxidative stress and structural tissue remodelling, ultimately compromising the functional and immune-privileged microenvironment necessary for optimal sperm production and transport. Diagnostic evaluation requires a multimodal approach incorporating clinical examination, microbiological testing, semen analysis and scrotal ultrasonography, with advanced imaging and molecular assays reserved for complex or equivocal cases. Management is individualized and may involve antimicrobial therapy, anti-inflammatory treatment, immunomodulation or microsurgical intervention in cases of ductal obstruction. Assisted reproductive technologies provide additional options when natural conception is not feasible. Despite increased recognition of their impact, chronic epididymitis and orchitis remain insufficiently studied, with gaps in standardized definitions, biomarker validation and long-term outcome data. This review provides a focused synthesis and phenotype-driven clinical framework for chronic epididymitis and orchitis through a fertility-preservation lens, bridging urological and andrological perspectives and integrating evidence on subclinical inflammation, contemporary diagnostic biomarkers and a staged therapeutic pathway.