Background: Prostate cancer in the Middle East and North Africa (MENA) region is characterized by late-stage symptomatic presentation and a mortality-to-incidence ratio approximately five times higher than Western screened populations. In 2023, Egypt established the first large-scale national PSA screening program within the Presidential Initiative for Cancer Early Detection. This study reports operational and clinical outcomes from the program's initial three years.
Methods: We conducted a retrospective analysis of national screening data from June 2023 through December 2025. The program targeted asymptomatic men aged 45-70 years using a risk-stratified PSA-based triage protocol. Diagnostic pathways included bi-parametric MRI for intermediate-risk individuals (PSA 10-20 ng/mL) and transrectal ultrasound-guided biopsy for high-risk cases (PSA >20 ng/mL or PI-RADS >3). A public-private partnership model integrated government hospitals with private laboratories offering faster result turnaround. Primary outcomes included screening adherence rate, PSA distribution, biopsy yield, and cancer staging.
Results: Over the study period, 557,719 men were referred for screening, with 170,710 completing PSA testing (overall adherence: 30.6%). Annual adherence increased progressively from 21.5% (2023) to 30.7% (2024) to 35.5% (2025). PSA distributions remained stable: 93.6% <4 ng/mL, 5.0% 4-9.99 ng/mL, 0.9% 10-20 ng/mL, and 0.5% >20 ng/mL. Of 1,509 men referred for MRI, 449 (29.8%) completed imaging. Among 950 men meeting biopsy criteria, 328 (34.5%) completed the procedure, yielding 188 malignancies (57% positive biopsy rate). Multidisciplinary staging of 106 cases revealed 89 (84%) localized and 17 (16%) metastatic cancers. Cancer detection rate: 1.1 per 1,000 screened.
Conclusions: The Egyptian Presidential Initiative achieved screening adherence comparable to established Western programs within three years. The favourable stage distribution among detected cancers suggests effective early detection. Substantial attrition at MRI and biopsy stages represents a critical implementation gap requiring intervention. This program provides a scalable model for prostate cancer screening in resource-variable settings.

Screening to diagnosis cascade