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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.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/feasibility-and-first-year-findings-of-a-pilot-program-of-prostate-cancer-screening-in-croatia-crostate/352287/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/feasibility-and-first-year-findings-of-a-pilot-program-of-prostate-cancer-screening-in-croatia-crostate/352287.png","ImageObject",300,407,{"name":92,"@type":93},"Olivia Brown","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-23","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":8},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Who was eligible to participate in the CROState pilot program?","Question",{"text":112,"@type":113},"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.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the diagnostic pathway work after elevated PSA?",{"text":117,"@type":113},"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.",{"name":119,"@type":110,"acceptedAnswer":120},"What were the key findings from the first year?",{"text":121,"@type":113},"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. 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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.  \nResults 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.  \nConclusion 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.  \nŽeljko 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  \n2University of Zagreb School of Medicine, Zagreb, Croatia  \n3Department of Urology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia 4Croatian Institute of Public Health, Zagreb, Croatia  \n5Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia  \n6Ministry of Health, Zagreb, Croatia  \nReceived: September 13, 2025  \nAccepted: November 24, 2025 Correspondence to:  \nTomislav Kuliš  \nDepartment of Urology University Hospital Center Zagreb Kišpatićeva 12  \n10000 Zagreb, Croatia  \n[tkulis@kbc-zagreb.hr](tkulis@kbc-zagreb.hr)  \nThis 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.   \nKaštelan et al: First-year findings of a pilot program of prostate cancer screening in Croatia  383  \nSince 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) .  \nThe 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.  \nSince the introduction of prostate-specific antigen (PSA) testing ","cbCainEqPphFLfet","https://ap.wps.com/l/cbCainEqPphFLfet","pdf",970500,"English","# Aim\n# Methods\n# Results\n# Conclusion\n# Background and Rationale","[{\"question\":\"Who was eligible to participate in the CROState pilot program?\",\"answer\":\"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.\"},{\"question\":\"How did the diagnostic pathway work after elevated PSA?\",\"answer\":\"Men with PSA \\u003e 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.\"},{\"question\":\"What were the key findings from the first year?\",\"answer\":\"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.\"}]","Feasibility and first-year findings of a pilot program of prostate cancer screening in Croatia (CROState) | PDF",1790098763]