Mapping the readiness landscape for prostate cancer screening in Europe: analysis of health system capacity across the PRAISE-U pilots.

BACKGROUND

Prostate cancer (PCa) remains the most frequently diagnosed cancer and a leading cause of cancer mortality among European men. To support the European Commission's call for organised, risk-stratified PCa screening, the PRAISE-U (PRostate cancer Awareness and Initiative for Screening in the European Union) pilots tested a designated pathway integrating prostate-specific antigen (PSA) testing, risk stratification and magnetic resonance imaging (MRI)-guided biopsy decisions.

METHODS

A formative readiness and capacity assessment was conducted across five PRAISE-U pilots in Lithuania, Lower Silesia (Poland), Manresa and Galicia (Spain), and Ireland. Data were triangulated from (1) desk reviews of legislation, screening policies, and relevant documentation; (2) facility-level assessments; and (3) multi-level stakeholder consultations collected between November 2023 and mid 2024. Finally 47 indicators across 11 domains were developed. Indicators were scored on a standardised 0-2 scale, aggregated at the domain level, and visualised using radar plots. The PRAISE-U was registered with ClinicalTrials.gov, number NCT06424275.

FINDINGS: Substantial heterogeneity was observed across sites. Clinical domains (PSA testing availability, diagnostics, treatment, infection control, multidisciplinary teams and active surveillance protocols) scored high across all pilots. However, the programmatic "front-end" elements (awareness activities, eligibility identification, counselling Standard Operating Protocol) and "back-end" elements (systematic tracking of screen-positives, Quality Assurance and registry linkage) were noted weak and heterogeneous across sites. Lithuania demonstrated the highest overall readiness, while other pilots faced challenges in population identification, data governance, and structured follow-up of screen-positive individuals.

INTERPRETATION: While European pilot sites show robust clinical capacity for PCa care, substantial gaps remain in the organisational, data, and quality-assurance components, that warranted an effective population-based, risk-stratified PCa screening.

FUNDING: This project has received funding from the EU4Health program under grant agreement 101101217, co-funded by the European Union.