Implementation and First Results of the Czech Nationwide Prostate Cancer Screening Pilot Program

Abstract

Background: In 2022, the European Union recommended piloting organized prostate cancer screening. Subsequently, the Czech Republic launched a nationwide pilot program fully reimbursed by public health insurance in January 2024 to reduce the high incidence of late-stage prostate cancer and the widespread unorganized prostate-specific antigen (PSA) testing. Objective: To describe the strategy, methodology, and first results of the Czech nationwide prostate cancer screening pilot program. Design, setting, and participants: We analyzed data from the first 12 mo of the program targeting men aged 50-69 yr without a previous diagnosis of prostate cancer. General practitioners and urologists offer men an initial PSA test. Those with PSA >= 3.0 lg/l are referred to certified urologists. Based on urology assessment, selected for magnetic resonance imaging (MRI) and, if indicated, targeted biopsy. Outcome measurements and statistical analysis: Reported key indicators are PSA testing coverage and overall use of prebiopsy MRI. Results and limitations: Screening was offered to 150 498 men; PSA results were available for 146 109 (97.1%) men, 8.8% of whom had PSA >= 3.0 lg/l. Within 6 mo, 67.2% of the men with PSA >= 3.0 lg/l underwent urological evaluation. From 2023 to 2024, the 2-yr PSA testing rate rose from 47.4% to 53.3%, and pre-biopsy MRI use increased from 28.0% to 38.3% (10.3 percentage-point difference, 95% confidence interval 8.3-12.2). Data on diagnostic outcomes are not yet analyzed.