BACKGROUND AND OBJECTIVE: In Europe, prostate cancer (PCa) is the most common cancer in men. Screening may therefore be crucial to lower health care costs, morbidity, and mortality. This systematic review aimed to provide a contemporary overview of the costs and benefits of PCa screening programmes. METHODS: A peer-reviewed literature search was conducted, using the PICO method. A detailed search strategy was developed in four databases based on the following key search terms: "PCa", "screening", and "cost effectiveness". Any type of economic evaluation was included. The search strategy was restricted to European countries, but no restrictions were set on the year of publication. KEY FINDINGS AND LIMITATIONS: A total of 7484 studies were identified initially. Of these, 19 studies described the cost effectiveness of PCa screening in Europe. Among the studies using an initially healthy study population, most focussed on risk- and/or age- and/or magnetic resonance imaging (MRI)-based screening in addition to prostate-specific antigen (PSA) testing and compared this with no screening. Incremental cost ratios (ICERs) varied from €5872 per quality-adjusted life year (QALY) to €372 948/QALY, with a median of €56 487/QALY. Risk-based screening followed by MRI testing seemed to be a more cost-effective strategy than no screening. CONCLUSIONS AND CLINICAL IMPLICATIONS: This systematic review indicates that screening programmes incorporating a risk-based approach and MRI have the potential to be cost effective. PATIENT SUMMARY: In this review, we looked at the cost effectiveness of prostate cancer screening in Europe. We found that a risk-based approach and incorporation of magnetic resonance imaging has the potential to be cost effective. However, there remains a knowledge gap regarding cost effectiveness of prostate cancer screening. Therefore, determinants of cost effectiveness require further investigation.

Cancer Center Department of Urology University Medical Center Utrecht Utrecht The Netherlands

Department of Public Health and Primary Care Ghent University Ghent Belgium

Department of Public Health and Primary Care Ghent University Ghent Belgium; Department of Internal Medicine and Pediatrics Ghent University Ghent Belgium

Department of Urology Clínico San Carlos University Hospital Madrid Spain

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

Department of Urology Sint Antonius Hospital Utrecht Nieuwegein The Netherlands

Europa Uomo Antwerp Belgium

European Association of Urology Policy Office Arnhem The Netherlands

European Association of Urology Policy Office Arnhem The Netherlands; Department of Urology KU Leuven Leuven Belgium

International Agency for Research on Cancer World Health Organization Lyon France

National Screening Centre Institute of Health Information and Statistics of the Czech Republic Prague Czechia; Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czechia

Swedish Institute for Health Economics Lund Sweden

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