In terms of extortion it's gonna be hard to keep that practice alive in the US. Especially since the Italian enclaves are much smaller nowadays, a lot of them have moved to the suburbs and the majority of the Italian Americans are thoroughly Americanized. An Italian American business owner that is victim of a shakedown? He won't hesitate to call the cops. Especially with how non-violent the American Mob is nowadays.

Who are they gonna extort? Albanians? Russians? Dominicans? Salvadorans? Puerto Ricans? Chinese? Vietnamese? Cambodians? Haitians? Cape Verdeans?
Those are the basically the only communities that still have fresh off the boat migrants (who don't dare to call the cops yet) arriving in northeast cities and are communities that have a substantial criminal activity going on over there - but they are already getting preyed upon by their own kind, their own criminal gangs. And the American Mob these days is not violent enough and lacks numbers to challenge the criminals in those communities.

You don't need large numbers to be influential in the underworld, as long as you stick to your last. In a lot of criminal areas Cosa Nostra still has the know-how and the reach the other gangs simply lack. There's - even today, no matter what state the Mob is in - not a single other type of organized crime group that conducts illegal gambling and loansharking with as much sophistication as Cosa Nostra does and not a single other type of organized crime group that has the know-how to make a ton of money of these rackets as Cosa Nostra can.
Just take a look at "Operation Shark Bait" in 2018. They had 3 million on the street generating a 1.3 million profit in a mere two years and this was just a Genovese associate we're talking about.
I can't take of another criminal enterprise with the same level of reach in that department.

Gambling and loansharking will always be in demand and the American Mob can and will continue to make a ton of money of this.

Drug trafficking, if we're talking about influencing the retail drug business? Not a chance.
Extortion? That's largely over.

There are still plenty of other rackets the American Mob, if they play it smart, can somewhat monopolize and off which they can still make more money than other criminal gangs are making off drug dealing, extortion, prostitution and local gambling.