With the new policy recommendation in 2022 to explore the possibilities of screening for prostate cancer by the European Commission, the landscape for prostate cancer early detection is evolving. In line with this recommendation, the PRAISE-U project aims to evaluate the early detection and diagnosis of prostate cancer through customised and risk-based screening programmes, with the goal to align protocols across European Union member states. This systematic review is part of the PRAISE-U project, with the goal to review the policy, medical guideline recommendations, and the current level of opportunistic screening presented in the scientific literature on prostate cancer early detection from 2016 to 2023 in European Union member states. An extensive literature search was performed on 1 June 2023 in a large number of databases, including Embase.com, Medline (Ovid), Web of Science Core Collection, Google Scholar, and Policy Commons. We identified 318 articles (qualitative, quantitative, and reviews), of which 41 were included in the full-text screening. Seventeen articles were ultimately identified as eligible for inclusion. The included articles revealed significant variations towards PSA-based early detection policies for prostate cancer in nine European countries. Despite official recommendations, opportunistic screening was prevalent across all nine countries regardless of recommendations for or against PSA-based early detection. This systematic review suggests that the current early detection policies are not fit for purpose. High levels of opportunistic screening and overdiagnosis persist, prompting policy recommendations for standardised guidelines, informed decision making, and increased awareness to improve efficiency and effectiveness in early detection.

Department of Urology Clínico San Carlos University Hospital 28040 Madrid Spain

Department of Urology Erasmus MC Cancer Institute University Medical Center Rotterdam 3015 GD Rotterdam The Netherlands

Department of Urology Gasthuisberg University Hospital Katholieke Universiteit Leuven 3000 Leuven Belgium

Europa Uomo 2018 Antwerp Belgium

European Association of Urology Policy Office 6842 CV Arnhem The Netherlands

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University 625 00 Brno Czech Republic

International Agency for Research on Cancer World Health Organization 69366 Lyon France

Medical Library Erasmus MC University Medical Center Rotterdam 3015 GD Rotterdam The Netherlands

National Screening Centre Institute of Health Information and Statistics of the Czech Republic 128 01 Prague Czech Republic

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