Reply to Jonas Hugosson. Population-based Screening for Prostate Cancer: Is It Time? Eur Urol. In press. https://doi.org/10.1016/j.eururo.2024.11.003

We read with interest the editorial by Professor Hugosson [1] reflecting on our manuscript on the current state of prostate cancer (PC) screening and future directions [2]. We would like to thank Professor Hugosson for his excellent views on the topic and take this opportunity to clarify the purpose of our review.
Contrary to what was suggested in the editorial, our manuscript is not merely a review of systematic reviews (SRs) of randomised trials of PC screening. Our focus was a comprehensive overview of all aspects of early detection of PC, including the pathway from invitation to diagnosis, and to address the harms and benefits and contemporary algorithms. In this way, our aim was to provide comprehensive and up-to-date evidence for different aspects of early detection of PC in the EU and UK. We acknowledge that the prostate-specific antigen (PSA)-based screening randomised trials included in the SRs are somewhat outdated. Nonetheless, important lessons have been learned from these trials that are driving current developments for modern (ie, individually tailored and risk-based) approaches. However, as highlighted in our discussion, there is no need to keep on looking back. We should start moving the dialogue forward. To do so, we included a section in our discussion that covers recent screening trials and strategies that have not yet been captured in an SR.
Looking to the future, we share Professor Hugosson’s optimism about the potential of modern screening strategies, including risk stratification (calculators) and magnetic resonance imaging in addition to PSA. It is encouraging that we may now be at a point at which the benefits of screening outweigh the harms, but only if we are able to offer well-organised programmes. As highlighted in both our review and Professor Hugosson’s editorial, we need to look beyond diagnostic strategies and acknowledge the entire pathway and broader societal aspects as well. Therefore, piloting of modern population-based screening pathways is crucial to assess their acceptability, feasibility, and sustainability within existing health care systems. This is currently being done in initiatives by the PRostate Cancer Awareness and Initiative for Screening in the European Union (PRAISE-U) project [3] and the Swedish Organised Prostate Cancer Testing (OPT) programmes [4] and will be further explored in EUCanScreen [5]. Indeed, we should be mindful that a screening programme will always improve over time. However, to achieve success, we must look beyond screening effectiveness alone and consider the various aspects related to PC screening, as demonstrated in our review.