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

Sep 22, 2026

The study evaluates feasibility, participation, diagnostic pathway performance, and early detection outcomes of the first year of the Croatian pilot prostate cancer screening program (CROState) implemented in Zagreb. A prospective pilot enrolled 55–69-year-old men without prior prostate cancer diagnosis or PSA testing in the prior 12 months. PSA testing identified elevated results in 8.5%, but repeat PSA completion was limited, affecting referral and downstream adherence. Advanced diagnostics and targeted biopsy were used, showing mostly clinically significant cancers.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

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Aim

Methods

Results

Conclusion

Background and Rationale

382 RESEARCH ARTICLE Croat Med J. 2025;66:382-9 [https://doi.org/10.3325/cmj.2025.66.382](https://doi.org/10.3325/cmj.2025.66.382) Feasibility and first-year findings of a pilot program of prostate cancer screening in Croatia (CROState) Aim 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. Methods 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 oneof 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. Results 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. Conclusion 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. Željko Kaštelan1,2, Tomislav Kuliš1,2, Igor Grubišić2,3, Ivana Brkić Biloš4, Maja Prutki2,5, Marija Bubaš6, Krunoslav Capak2,4 1Department of Urology, University Hospital Center Zagreb, Zagreb, Croatia 2University of Zagreb School of Medicine, Zagreb, Croatia 3Department of Urology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia 4Croatian Institute of Public Health, Zagreb, Croatia 5Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia 6Ministry of Health, Zagreb, Croatia Received: September 13, 2025 Accepted: November 24, 2025 Correspondence to: Tomislav Kuliš Department of Urology University Hospital Center Zagreb Kišpatićeva 12 10000 Zagreb, Croatia [tkulis@kbc-zagreb.hr](tkulis@kbc-zagreb.hr) This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY-NC-ND 4. 0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Kaštelan et al: First-year findings of a pilot program of prostate cancer screening in Croatia 383 Since 2016, prostate cancer has been the most common malignant disease among Croatian men and the third leading cause of death (1,2) . It is also the most prevalent cancer in the Western and developed world, which makes it a major public health concern (3) . The Europe’s Beating Cancer Plan by the European Council in December 2022 recommended establishing screening programs for prostate cancer in member countries (4) . The EU-funded PRAISE-U project is implementing five different pilot programs to collect relevant data on how to effectively design screening programs (5) . Croatia has recognized prostate cancer as an important issue, and the Ministry of Health established a working group to develop recommendations for a national screening program. Since the introduction of prostate-specific antigen (PSA) testing

FAQs

Who was eligible to participate in the CROState pilot program?

Men aged 55–69 years with no prior prostate cancer diagnosis and no PSA testing in the past 12 months were invited. Recruitment was conducted by general practitioners.

How did the diagnostic pathway work after elevated PSA?

Men with PSA > 4 ng/mL had repeat testing. If PSA was elevated again, they were referred to one of two university hospitals for further evaluation, including multiparametric MRI, urological examination, and transperineal fusion biopsy when indicated.

What were the key findings from the first year?

Out of 5,251 invited men, 93.9% participated in PSA testing and 8.5% had elevated PSA. Most cancers detected were clinically significant, but only two men met criteria for active surveillance. The main challenge was incomplete adherence to repeat PSA testing.

Sep 22, 2026

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