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 µg/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 µg/l. Within 6 mo, 67.2% of the men with PSA ≥3.0 µg/l underwent urological evaluation. From 2023 to 2024, the 2-yr PSA testing rate rose from 47.4% to 53.3%, and prebiopsy 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.Conclusions
These results demonstrate the feasibility of transforming widespread unorganized PSA testing into an organized screening program with improved adherence to the recommended diagnostic pathway. Further evaluation to assess outcomes and efforts to reduce opportunistic testing will follow.