Five European pilot sites demonstrated strong clinical capacity for prostate cancer screening but lack coordinated screening infrastructure, with key gaps in population identification, standardized procedures, and data systems needed for organized, risk-stratified screening programs.
- Clinical strengths: All five sites (Lithuania, Poland, Spain, Ireland) have PSA testing, MRI capacity, trained radiologists, and multidisciplinary teams available
- Infrastructure weaknesses: Sites struggle with identifying eligible populations, standardized invitation procedures, systematic follow-up tracking, and linking screening data to cancer registries
- Risk stratification benefit: Implementing formal risk assessment before MRI could prevent radiology overload and make screening sustainable at population scale
- Organizational needs: Successful implementation requires coordinated architecture including eligibility identification, balanced counseling, structured follow-up, and interoperable data systems
- No one-size-fits-all approach: Different European health systems need tailored investments, with Lithuania requiring minimal optimization while others need extensive organizational reform
Prostate cancer is the most frequently diagnosed cancer and the third most common cause of cancer death among European men. Although screening may support earlier detection, reliance on prostate-specific antigen (PSA) testing alone raises concerns about false-positive results, unnecessary biopsies, overdiagnosis, and overtreatment.
A study published online August 6 in eClinicalMedicine therefore assessed whether five European pilot sites were prepared to implement organized, risk-stratified screening. The evaluation formed part of the EU-funded Prostate Cancer Awareness and Initiative for Screening in the European Union (PRAISE-U) project and included Lithuania, Lower Silesia in Poland, Manresa and Galicia in Spain, and Ireland.
The PRAISE-U pathway combines PSA testing with an initial risk assessment to determine the need for MRI, followed by further risk stratification to guide biopsy decisions.
Clinical capacity is generally strong
The researchers assessed the sites using 47 indicators across 11 domains. All five demonstrated strong clinical capacity, including access to PSA testing, MRI, trained radiologists, biopsy services, multidisciplinary teams, treatment facilities, infection-control procedures, and active-surveillance protocols.
Lithuania demonstrated the highest overall readiness. It was also the only participating site with an existing population-based PSA screening program, although the program still required closer alignment with the organized, risk-stratified PRAISE-U pathway. PSA testing at the other sites was predominantly opportunistic.
However, none of the five sites used a validated first-level risk-stratification tool before the PRAISE-U project.
MRI was available and interpreted by trained radiologists at every site. Lithuania and Galicia used multiparametric MRI, while Lower Silesia, Manresa, and Ireland used biparametric MRI. Only Poland and Manresa reported double reading of MRI examinations.
Although every site used MRI findings to inform biopsy decisions, none had implemented the complete PRAISE-U pathway, including formal risk stratification before MRI and a second risk assessment to guide biopsy decisions.
Fragmented screening infrastructure
The weakest areas were largely outside the examination room. These included identifying eligible populations, providing targeted awareness activities, establishing standardized invitation and counselling procedures, systematically tracking screen-positive participants, and implementing prostate-specific quality assurance.
Poland and Ireland experienced difficulties identifying the eligible screening population. Poland and Manresa did not have documented referral pathways for individuals with elevated PSA results.
Only the two Spanish sites systematically tracked screen-positive participants. At the remaining sites, follow-up was largely dependent on individual clinicians.
Data infrastructure presented another significant weakness. Although all five sites used digital medical records and had designated data managers, none could link prostate screening data to national cancer registries. This could make it difficult to monitor participation, diagnoses, treatment, and long-term outcomes across an organized screening program.
Risk stratification could protect MRI capacity
The authors warned that performing MRI in every man with an abnormal PSA result, without first applying risk stratification, could overload radiology services and become unsustainable if screening were expanded to the population level.
The findings suggest that, at these pilot sites, the principal challenge was not simply scanner or treatment capacity. Successful implementation will require a coordinated screening architecture encompassing eligibility identification, invitations, balanced information and counselling, risk stratification, structured follow-up, quality assurance, and interoperable data systems.
The authors also cautioned against a one-size-fits-all European model. Different health systems will require different investments, with Lithuania needing comparatively limited optimization and other sites requiring more extensive organizational reform.
Because the assessment covered five implementation pilots rather than a representative sample of European health systems, its findings should not be interpreted as a continent-wide estimate of readiness.
The assessment examined readiness before implementation and did not determine whether the PRAISE-U screening approach reduces prostate cancer mortality, overdiagnosis, unnecessary biopsies, or costs.
Read the full study here.
