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.

Background: Prospective trials provide robust evidence for prostate cancer (PCa) treatment but often include highly selective populations, limiting generalizability. Real-world data (RWD) can address these gaps and inform personalized care. Objectives: This study aimed to evaluate treatment-free survival (TFS) and secondary treatment sequences after initial curative therapy for PCa using electronic health record (EHR) data and to analyze associated medication profiles. Methods: We studied 3024 patients treated with radical prostatectomy (RP), brachytherapy (BT), or curative radiotherapy (RT) at Erasmus MC (2009–2023), the Netherlands. Outcomes included TFS, treatment sequences, and medication patterns across treatment lines. Results: Median age at diagnosis was 65 years (IQR 61–69) for RP, 68 (62–73) for BT, and 72 (68–76) for RT. At 10 years, TFS was 89% (95% CI: 84.9–94.1) for BT, 85% (95% CI: 83–87) for RT, and 71% (95% CI: 65.7–75.8) for RP. Most patients remained treatment-free, but up to five treatment lines occurred, mainly in patients with low comorbidity scores. Medication profiles reflected treatment-related morbidity: alpha-blocker use increased after BT and RT, while bladder relaxants were common after RP. Comorbidity-related medication use remained low among patients undergoing multiple sequenced treatments. Conclusions: These findings highlight the real-world application of multiple secondary treatments after different primary curative therapy options for PCa and associated comorbidity and medication use patterns. They confirm the durability and long-term effectiveness of curative treatments in real-world PCa care. By combining treatment trajectories and medication profiles, RWD provides insights for personalized counseling, helping clinicians and patients anticipate long-term treatment needs, and enabling informed decisions aligned with health status and preferences.