By Daniel Sandford
BBC News, Rome
Silvio Berlusconi's meeting with US President George W Bush in Washington on Monday comes as the Italian prime minister faces mounting pressure at home ahead of elections in April.
Critics accuse Mr Berlusconi of changing the rules in his favour
With less than six months to go before his chosen election date Mr Berlusconi appears to be in political trouble.
He has named 9 April as the day the country will vote to choose its next government.
But, under pressure from the left and the right, it is looking increasingly likely he may not be the man who leads the new administration.
At the root of his difficulties is the Italian economy, which has failed to recover with any great vitality.
Despite the security the euro brings, the population is feeling the pinch. Entry into the eurozone was accompanied by an increase in prices; and competition from China and India has left Italy's traditional small businesses struggling.
Then there was the involvement in the deeply unpopular Iraq war.
He has also had to endure a series of court cases against him alleging corrupt business practices, illegal party funding and bribery of judges. He has survived them all.
Many of his acquittals have been under a statute of limitations law he introduced himself, which shortened the amount of time allowed between an alleged offence and a trial.
A new case began last Friday, this time accusing him of fraud and money-laundering, and that may still be hanging around his neck at the time of the election.
Mr Berlusconi is the longest-serving Italian prime minister of the modern era, but he is having difficulty securing a legacy.
His opponents claim he has turned to what he knows best - changing the rules of the game in what they say is an attempt to shore up his position.
The Italian left, in a rare moment of unity, held its first US-style primary on 16 October.
Mr Berlusconi is upset by the Rockpolitick TV show
It now has one clear leader, the former European Commission President Romano Prodi.
With the opinion polls massively in the left's favour it looks like it could secure a good majority in the election under Italy's hybrid system.
Currently, three-quarters of Italian members of parliament are chosen using the first-past-the-post system, with the remainder coming from party lists.
But the government is trying to alter that ahead of the election. Mr Berlusconi wants to change the system back to full proportional representation. The left say that is because he is trying to minimise the damage of an election defeat.
He is under some pressure from within his own cabinet, too.
Foreign Minister Gianfranco Fini says that if his right-wing Alleanza Nazionale (National Alliance) gets more seats than Mr Berlusconi's Forza Italia in the election, then he would expect to take over the job of prime minister.
Mr Berlusconi is also trying to use his sizeable majority to make the most significant changes to the Italian constitution since 1948.
The plans before parliament would take some of the executive power away from the president of the Republic and give it to the prime minister. They would also devolve power to the regions, a move popular with Mr Berlusconi's long time allies the Northern League.
Despite owning three television stations, and having seen some staff at the state-owned Rai sacked after he criticised them, Mr Berlusconi has been complaining of bias on TV.
In particular, he has attacked the recent Rockpolitick programme on Rai Uno, in which ageing rock star Adriano Celentano has been complaining that Italy does not have a wholly free press.
At the same time, Mr Berlusconi says he wants to see a complete liberalisation of the rules on political broadcasting. His opponents claim this would allow him to pump out propaganda on the television stations he controls.
Will the changes be enough to help him win? Well, as the results in the German elections showed, anything is possible; and Mr Berlusconi has huge resources at his disposal.
But many political analysts think the public has tired of a man perceived by many to have used his time in office to help himself and his close associates, and not the Italian people.