PRAISE-U initiative: An update on the rapidly evolving landscape of PCa screening in Europe

An important push towards the actual implementation of contemporary algorithms for early detection came from the European Commission on 20 September 2022 as part of Europe’s Beating Cancer Plan. The European Commission proposed a recommendation to investigate the prostate, lung, and gastric cancer early detection programmes. An amended version of this Commission proposal was approved by all EU member state governments on 9 December 2023. This opened a new window of opportunity to move away from the trial setting to population-based early detection settings.

The updated European recommendation emphasised the importance of a stepwise approach involving pilot programmes and further research to assess the feasibility and effectiveness of an organised screening programme for PCa [3]. These pilot programmes should invite men at risk and apply individual retesting intervals, using PSA testing for initial screening and follow-up tests including individual risk assessment and MRI before considering prostate biopsy. In addition, the expected limited number of men diagnosed with low risk disease should be discouraged from choosing to undergo active therapy.

In line with this recommendation, in 2023, the “PRostate cancer Awareness and Initiative in the EU” (PRAISE-U) consortium was formed. The PRAISE-U Project, which is led by the EAU, aims to provide concrete evidence on a risk-stratified approach to the early detection of PCa outside a trial setting.

The fi rst milestone of PRAISE-U was to get a comprehensive overview on the state-of-play across EU Member States with respect to ongoing PCa early detection/screening practices and to get insight on needs for initiation of a national individualised risk-based PCa screening programme. This major task was completed in 2024 and resulted in five publications which are freely accessible through the PRAISE-U knowledge hub (https://uroweb.org/praise-u/news).

Getting insights in the state-of-play on PCa screening in all Member States in Europe has resulted in an unprecedented source of information. With the support of national urology associations fact sheets have been created which provide essential information for all stakeholders in the field of prostate cancer early detection. The fact sheets including an interactive map with epidemiological data is available in the PRAISE-U knowledge hub (https://uroweb.org/praise-u/results.)

Insight into the European Member States health policy documents and mapping barriers for implementing population-based programmes made clear that despite offi cial recommendations, opportunistic PSA-based screening was prevalent across all Member States included in the survey and that this uncontrolled testing was done regardless of recommendations for or against PSA-based early detection. Organised screening programmes could help to reduce or even prevent these often harmful opportunistic testing practices. However, in all 27 Member States that participated in our survey, the absence of a population-based programme was attributed to resource limitation and a lack of political and medical society support. It goes without saying that these factors are essential for a successful implementation and will require our continuous attention.

In the 18 months that PRAISE-U has existed, it has done more and is currently coordinating five population-based prostate cancer screening pilots in four different Member States (fi gure 2). These pilots required a thorough upfront health systems capacity assessment which was completed in the past year and resulted in a tailored screening algorithm based on the PRAISE-U screening algorithm (figure above). This nationally tailored screening algorithm will serve as a valuable reference framework for scaling and adapting screening efforts in other EU regions, ensuring that lessons learned are effectively applied to enhance healthcare readiness.

Apart from a feasible screening algorithm from a clinical point of view, communication to the eligible male population is key. No (cancer) screening programme will be effective if there is low compliance in the target population. Within PRAISE-U visually appealing and accessible information sheets, and video have been developed to support optimal compliance. (https://www.youtube.com/watch?v=8SXxXi7QnvI)

PRAISE-U is now in a phase that five well-designed, nationally/regionally tailored pilot studies are on the way. All the work we have done so far enables us to help other Member States which, following the EU recommendations have decided to start up pilot studies on PCa screening. In addition, PRAISE-U is closely working with the so-called EUCanScreen initiative which started last year. Within EUCanScreen, an European Joint Action on cancer screening, at least an 10 additional Member States will start population-based prostate cancer screening pilot studies.

With PRAISE-U and EUcanScreen joining forces, we will add the indispensable knowledge of implementation of national population-based programmes to the existing and ongoing PCa screening trial data. We envision a Europe free from harmful, uncontrolled opportunistic screening practices, and have organised state-of-the-art nationally and individually tailored screening programmes instead. This is the only way to reduce prostate cancer related morbidity and mortality.

Join the following lectures at EAU25 to learn more:

• Sunday, March 23 10:45 – 12:30 – Early detection and diagnostic pathways in prostate cancer revisited
• Sunday, March 23 13:30 – 15:00 – Europe’s Beating Cancer Plan: What impact for uro-oncology?