Implementation and first results of the Czech nationwide prostate cancer screening pilot programme

Abstract Background In 2022, the European Union recommended piloting organised prostate cancer screening. Subsequently, the Czech Republic launched a nationwide pilot programme fully reimbursed by public health insurance in January 2024 to reduce the high incidence of late-stage prostate cancer and the widespread unorganised prostate-specific antigen (PSA) testing. Objective To describe the strategy, methodology, and first results of the Czech nationwide prostate cancer screening pilot programme. Methods We analysed data from the first 12 months of the programme, which targets men aged 50–69 years without a previous prostate cancer diagnosis. General practitioners and urologists offer men an initial PSA test. Those with PSA ≥3.0 µg/l are referred to certified urologists, based on urology assessment selected for magnetic resonance imaging (MRI) and, if indicated, targeted biopsy. Reported key indicators are PSA testing coverage and overall use of pre-biopsy MRI. Key Findings and Limitations Screening was offered to 150,498 men; PSA results were available for 146,109 (97.1%), 8.8% of whom had ≥3.0 µg/l. Within 6 months, 67.2% with PSA ≥3.0 µg/l underwent urological evaluation. From 2023 to 2024, the 2-year PSA testing rate rose from 47.4% to 53.3%, and pre-biopsy MRI use from 28.0% to 38.3% (10.3 percentage-point difference, 95% CI 8.3–12.2). Data on diagnostic outcomes are not yet analysed. Conclusions and Clinical Implications These results demonstrate the feasibility of transforming widespread unorganised PSA testing to an organised screening programme with improved adherence to the recommended diagnostic pathway. Further evaluation to assess outcomes and efforts to reduce opportunistic testing will follow. Advancing Practice What does this study add? This is the first population-level evaluation of a nationwide organised prostate cancer screening programme in Central Europe. The findings demonstrate the feasibility of integrating a structured screening programme with PSA testing in routine primary care into a national health system. The programme improved adherence to guideline-based diagnostic pathways. Patient Summary This report presents the initial results of a new nationwide, organised prostate cancer screening programme in the Czech Republic. The programme contributed to increased screening coverage in the target population (50-69 years) and improved the use of MRI before biopsy, which is now the recommended practice.