Swedish regional population-based organised prostate cancer testing: why, what and how?

Abstract

Objective: This study aimed to describe the regional, population-based, organised prostate cancer testing (OPT) programmes that are being introduced throughout Sweden: motives, structure, target population, diagnostic algorithm, quality control, outcomes, research, and future perspectives.

Results: In 2018, the Swedish National Board of Health and Welfare renewed their recommendation against screening for prostate cancer. Despite this, regional OPT was considered motivated to (1) improve cost-effectiveness compared with unorganised testing, (2) improve equity by giving every man in the target population a chance to make an informed choice, and (3) gain diagnostic and organisational knowledge. The OPT programmes are provided as a regional public healthcare service. They are coordinated by a national working group. The final target population is all men aged 50-74 years. Regional OPT offices use a national administrative system to organise all steps from sending invitation letters to prostate biopsy according to a strict diagnostic algorithm. General practice is involved for blood draw only or not at all. Data are registered in a national register (SweOPT); an annual report is published with the regions' performance on key indicators. At the end of 2024, 16 of the 21 Swedish regions had started OPT and invited 256,000 men with an average cumulative participation rate of 43%. A consortium co-ordinates OPT-related research. A general experience is that communication and organisational matters have been more challenging than medical decisions.

Conclusions: The Swedish population-based OPT programmes provide organisational experiences, diagnostic outcomes, and research results of value for future national prostate cancer screening programmes.