- Studies show a notable increase in mortality from prostate cancer among men who did not participate in screening programs, as revealed by a comprehensive European study.
- The reluctance to undergo screening stems from a variety of factors, including potentially inadequate awareness about the screening’s pros and cons.
- Prostate cancer ranks as the second most prevalent cancer in men following skin cancer.
A significant European study has found that men who bypass prostate cancer screenings are at a heightened risk of death from the disease. This raises important questions about the underlying reasons for their reluctance and how to better motivate attendance.
Men are often presented with the option to screen for prostate cancer using the prostate-specific antigen (PSA) test. Despite this, many choose not to participate, potentially endangering their health.
An in-depth analysis of the European Randomized Study of Screening for Prostate Cancer (ERSPC), the largest of its kind globally, pointed out that not attending screenings is a major risk factor for mortality.
The findings were unveiled at the European Association of Urology Congress 2025, which took place from March 21–24 in Madrid, Spain, though they have yet to be peer-reviewed.
In this subanalysis, researchers looked at over 72,000 men who were invited to participate in the screening, tracking their health over two decades.
It was noted that approximately one in six men (more than 12,400) avoided all their screening appointments, which resulted in a 45% increased risk of dying from prostate cancer compared to those who participated in the screenings.
The PSA test, while historically controversial, is gaining traction as beneficial due to new research and developments in the field.
“The evidence clearly shows it saves lives, but the debate has been about whether the side effects outweigh the benefits,” explained Robert Smith, PhD, Senior Vice President of Early Cancer Detection Science at the American Cancer Society, who was not part of the study.
“These findings from a robust, long-term study clearly demonstrate the significant benefits of screening,” he added.
23% Reduction in Prostate Cancer Mortality with Screenings
Researchers at Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands, conducted a study titled “The good, the bad, and the ugly,” which highlighted both the advantages and challenges associated with PSA testing.
Participants, who were between 55 and 69 years of age, were divided into two groups: those invited to screenings and those who were not (the control group).
Within the group invited to screenings, a significant number of men, referred to as “non-attenders,” chose to skip their appointments.
The study found that non-attenders had a 39% higher risk of dying from prostate cancer than the control group, while those who attended had a 23% lower risk.
It’s important to note that the benefits of screening might be underestimated due to the inclusion of non-attenders in the overall data, which can skew the results.
“When non-attenders are included in the data, they can diminish the apparent benefits of screening,” noted Geoffrey Sonn, MD, Associate Professor of Urology at Stanford Medicine, who was not involved in the study.
On the other hand, the risk of dying from prostate cancer significantly increases for those who do not participate in screening compared to those who do.
“This kind of long-term, randomized data is crucial to dispelling earlier doubts about the effectiveness of PSA testing,” Jeffrey Tosoian, MD, MPH, Assistant Professor of Urology and Director of Translational Cancer Research at Vanderbilt University Medical Center, who also was not part of the study, told Healthline.
“The real challenge is implementing practical strategies that can reach men across diverse cultural and socioeconomic backgrounds,” said Renée Leenen, MD, a PhD candidate and the study’s lead author, in a discussion with Healthline.
Factors Contributing to Missed Prostate Cancer Screenings
The complexities behind why men miss prostate cancer screenings extend beyond the scope of this study, but Healthline spoke with experts who suggested several plausible reasons.
“There’s a distinct difference in behavior between someone who participates in a trial but does not follow through with screenings. They generally may not engage much in preventive care,” explained Sonn.
Skipping screenings might indicate a general avoidance of healthcare, suggested Tosoian, noting that outdated or incorrect perceptions about PSA testing could also deter attendance.
“Some men might remember hearing outdated information about the ineffectiveness of PSA screening and never bother to update their understanding,” he said.
Leenen mentioned several barriers to screening, including:
- Logistical issues like time and financial constraints.
- A lack of understanding about prostate cancer risks.
- Inadequate knowledge about the benefits of screening, particularly among younger men.
Prostate Cancer: A Significant Health Issue for Men
Prostate cancer is only second to skin cancer as the most common type of cancer affecting men. The American Cancer Society states that about
Annually, there are approximately 1.4 million new cases of prostate cancer worldwide. However, projections by
With the rising incidence of prostate cancer, what can be done to address the issue of the 1 in 6 men who actively avoid screening?
“Educating the population about the risks of prostate cancer is essential,” Tosoian emphasized.
While current screening guidelines for prostate cancer are more restrictive compared to other cancers, men at average risk are advised to consider screening starting at age 50, and those at higher risk may start as early as 40.
According to Leenen, the most crucial element in encouraging men to participate in screenings is the influence of social connections.
“If a friend or family member encourages a man to consider screening, especially if they have personal experience with cancer, it significantly increases the likelihood of participation,” she explained.
Leenen highlighted the importance of education on the risks, the recommendation by doctors, and the prioritization of personal health care as key motivators for men to undergo screening.
“Partners play a particularly vital role in encouraging screening among men,” she added.