Engagement of general practitioners in prostate cancer screening – learnings from PRAISE-U pilot sites

Prostate cancer is a common disease affecting men, and finding it early can save lives. However, deciding how to look for it in a large population is a complex puzzle. The challenge lies in balancing two competing needs: reaching enough men to catch the disease early, while avoiding unnecessary tests that cause worry and waste resources. In many countries, the family doctor, known as a general practitioner, sits at the center of this puzzle. These doctors are the first point of contact for most people, holding a unique position of trust. They know their patients' histories and can offer advice that feels personal rather than bureaucratic. The question researchers have long asked is whether these doctors should lead the effort to invite men for screening, or if a central government system should handle the invitations while doctors simply wait to see the results.

A new study called PRAISE-U set out to test these different approaches across five European locations. The project aimed to see how best to organize a risk-based screening program for prostate cancer, where men are invited based on their specific risk factors rather than a blanket rule for everyone. The researchers focused heavily on the role of the family doctor in each location, observing how their involvement changed the outcome. They found that the success of the program depended less on the technology used to send invitations and more on how well the local system respected the relationship between the doctor and the patient. When the family doctor was an active partner in the process, men were more likely to participate. When the doctor was left out or burdened with too much extra work without support, participation dropped or the program had to change course.

In the town of Manresa, Spain, the team tried a model where the family doctors took the lead. Because the local healthcare system is integrated, these doctors could easily reach their patients. They sent personalized letters, shared videos, and used social media to explain the study. They also guided men through the steps of the screening and answered questions. Because much of the paperwork was handled automatically by computers, the doctors did not feel overwhelmed by extra work. This approach worked very well, with 43 percent of the invited men choosing to participate. The success here suggests that when doctors are empowered and supported by efficient systems, they can effectively mobilize their communities.

In the Galicia region of Spain, the approach was slightly different. Here, invitations were sent out centrally by the regional government via text message and mail. The family doctors were not the ones sending the letters, but they played a crucial supporting role. They were given clear information so they could advise their patients if asked. Because patients in this region rely heavily on their doctors for health decisions, the doctors' ability to explain the program helped many men decide to join. This model also achieved a participation rate of over 40 percent. It showed that even when the government leads the logistics, the doctor's voice remains essential for convincing people to take part.

Poland offered a different perspective. In this country, family doctors are the gateway to healthcare for nearly everyone, but they do not usually manage cancer screening programs. The researchers introduced a structured screening model coordinated by an oncology center but supported by local doctors. They found that when men received an invitation that mentioned it was issued on behalf of their own doctor, they were much more willing to listen. The data showed that records kept by the doctors were far more complete than those from government databases. This experience highlighted that while doctors may not want to manage the entire system, they are willing to take responsibility for the screening if the process is clear and if they can vouch for it to their patients.

In Ireland, the story took a different turn. Family doctors there are central to the current system, but when they were asked to join the PRAISE-U pilot, they declined. Their main concern was that the project would create a heavy workload for them to monitor the men who were screened, without enough resources to pay for that extra time. Because of this feedback, the researchers changed the plan. They redesigned the study so that men could receive invitations directly and send blood samples from home, removing the need for the doctor to be involved in the initial steps. This change was necessary to make the program work in that specific setting. However, the experience reinforced the idea that programs involving doctors are generally better at recruiting patients, leading to plans for a future version of the study that will offer men a choice between home testing and doctor-led testing.

Lithuania provided a clear lesson on communication. The country has had a national screening program for years, but it struggled with low effectiveness because it lacked coordination. The pilot tested a new method in two family medicine centers. In one group, doctors used personalized phone calls to reach out to men. In the other, they relied only on written letters. The centers using the phone calls achieved almost twice the participation rate of those using only letters. This result confirmed that direct, proactive communication from a trusted doctor is far more powerful than passive information. It also pointed to the need for better infrastructure, training, and financial support for doctors who do this outreach work.

The overall picture from these five sites is clear. When family doctors play an active role in organized screening, more men participate. Their involvement goes beyond simply referring a patient; it includes educating them, helping them make informed choices, and providing follow-up care. The trust that men place in their own doctor consistently improves their willingness to get screened. However, this success does not happen automatically. It requires a system that is organized, automated, and properly funded so that doctors are not burdened with excessive paperwork. The evidence suggests that the most effective programs will combine central coordination with the active, trusted voice of the family doctor. This partnership allows healthcare systems to reach men in a way that is efficient, fair, and centered on the patient's needs.