Prostate cancer (PCa) poses a significant global health threat, with high incidence and mortality rates. In 2022, the Council of the European Union (EU) updated its screening recommendations, prioritizing PCa screening. This signals a crucial step towards establishing new early detection programmes in EU member states. This study investigates the role of policy makers and governance in cancer screening to inform the development of PCa screening. We had a mixed-method study design. First, a rapid review was conducted on policy making and governance in EU-funded cancer screening initiatives. Second, a focus group discussion reviewed study concepts and methods. Third, a systematic literature review was performed and, fourth, a series of in-depth interviews with actors involved in PCa screening pilots was conducted. Data were analysed thematically and the findings are used to propose 10 recommendations for policy makers. The results of the rapid review and focus group discussion framed the study in the context of existing cancer screening programmes across the EU, and highlighted what already exists in terms of governance tools and methodology. The literature review and in-depth interviews presented key learnings from the literature and real-life settings. These findings are reported using a pre-existing conceptional framework for effective health system governance. The study underscores the critical importance of governance in effective cancer screening programmes. Ten recommendations are proposed, including: defining cancer screening governance, allocating budgets and defining common approaches and key performance indicators for evaluation, establishing methods to enhance citizen participation, and reinforcing network governance.

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

Department of Urology KU Leuven Leuven Belgium

Former European Commission's Directorate General for Health and Food Safety Luxembourg

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

International Agency for Research on Cancer World Health Organization Lyon France

London School of Hygiene and Tropical Medicine London United Kingdom

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

Policy Office European Association of Urology Arnhem The Netherlands

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