[Screening for prostate cancer; a screening program is favored over current opportunistic testing]

In The Netherlands, no national prostate cancer (PCa) screening program exists, despite evidence that screening can reduce mortality and metastasis. Overdiagnosis, a primary concern, is considered too detrimental to justify population-based screening. However, individual early detection through PSA testing is widely practiced, particularly in older men who may derive limited benefit. Variations in patient access to information, health literacy, and general practitioners' screening policies, coupled with high referral rates to secondary care, contribute to inefficiency, overdiagnosis, and social inequality. An organized modern risk-based, imaging-guided screening approach should aim to: (1) reduce disease burden by decreasing mortality and metastases, and enhancing the quality of life in those who would benefit from early detection, (2) minimize unnecessary testing and overdiagnosis in men unlikely to benefit. A pilot implementation study is essential to provide the data required to determine the feasibility and sustainability of a potential national screening program.