Feasibility and first-year findings of a pilot program of prostate cancer screening in Croatia (CROState)

To evaluate the feasibility, participation rate, diagnostic pathway performance, and early detection outcomes of the first year of the Croatian pilot prostate cancer screening program (CROState) implemented in Zagreb.

This prospective pilot program invited men aged 55-69 years without a prior prostate cancer diagnosis or prostate-specific antigen (PSA) testing in the past 12 months. Recruitment was conducted by general practitioners. Men with PSA>4 ng/mL underwent repeat testing, and if PSA was elevated again, they were referred to one of two university hospitals for further evaluation. The diagnostic pathway included multiparametric magnetic resonance imaging, urological examination, and transperineal fusion biopsy when indicated. All confirmed cancer cases were reviewed by a multidisciplinary team.

A total of 5251 men were invited to the program, of whom 4930 (93.9%) participated in PSA testing. Elevated PSA was detected in 419 (8.5%). Only 157 (37.5%) men completed repeat PSA testing, and 123 men were referred for hospital evaluation. Eighty-eight patients completed advanced diagnostics, with 83 undergoing magnetic resonance imaging. Forty-two men proceeded to biopsy, of whom 27 had positive results (64.3%). Most cancers were clinically significant; only two men fulfilled criteria for active surveillance. The main challenge was incomplete adherence to repeat PSA testing.

The CROState pilot demonstrated high initial participation and high detection rate of prostate cancer, with a few clinically insignificant tumors, when combining PSA testing with advanced imaging and targeted biopsy. Limited compliance with repeat PSA testing must be addressed before wider national implementation.