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Avoidance of prostate cancer screening linked to increased risk of PCSM
Author(s):
“Our study identifies that men who were invited for screening, but do not attend screening appointments are at significantly higher risk of dying from prostate cancer compared to men who were not offered screening or accepted an invitation for screening,” says Renée Leenen MD.
A subanalysis from the European Randomized study of Screening for Prostate Cancer (ERSPC) showed that participants who failed to attend a prostate cancer screening session despite being invited faced an increased risk of prostate cancer-specific mortality (PCSM).1
The ERSPC included men aged 55 to 69 years.
Conversely, those who did attend a screening session demonstrated a 23% reduced risk of PCSM. The data were presented at the 40th Annual European Association of Urology Congress in Madrid, Spain.
“Our study identifies that men who were invited for screening, but do not attend screening appointments are at significantly higher risk of dying from prostate cancer compared to men who were not offered screening or accepted an invitation for screening,” explained lead author, Renée Leenen MD, a PhD researcher at the Erasmus MC Cancer Institute, in a news release on the findings.2 “We need to better understand who these men are, why they choose not to attend appointments, and how to motivate them. This will help us to design population-based prostate cancer screening programs that encourage higher rates of informed participation. Tackling attendance rates in this way could be a big factor in the long-term success of a national prostate screening program.”
Overall, the ERSPC included men aged 55 to 69 years who were randomly assigned to the screening arm (n = 72,460) or to the control arm (n = 88,920). Participants were recruited across Finland, the Netherlands, Italy, Sweden, Switzerland, Belgium, and Spain. Follow-up was conducted over 20 years.
Participants in the screening arm who did not attend any of the screening rounds offered were considered non-attenders. In total, 12,401 (17%) participants in the study were non-attenders.
Data showed a rate ratio (RR) of 1.39 (95%CI 1.18-1.63) when comparing non-attenders vs the control arm and 0.77 (95%CI 0.69-0.85) when comparing attenders with the control arm. In other words, compared to the control group, non-attenders demonstrated a 39% increased risk of PCSM, while attenders demonstrated a 23% lower risk.
The authors noted, “Sensitivity analysis showed no stat. sig. differences between pre- or post-randomization consent (sHR, 0.71; 95% CI, 0.46-1.29).”
When comparing the attenders vs the non-attenders, those who attended a screening session demonstrated a 45% (RR, 0.55; 95% CI, 0.47-0.65) decreased odds of PCSM.
According to Tobias Nordström, MD, PhD, of the Karolinska Institute in Sweden, these data suggest that the benefit of screening may be greater than previously assumed.
“For countries around Europe that are planning to introduce a national prostate screening program, this analysis focusing on attendance shows that men who participate in screening have a much-improved long-term benefit than what we’ve seen from previous studies,” he said in the news release.2
However, in the non-responders arm, these findings may point to a group of men who need extra attention. According to Leenen, the choice to not participate in screening may reflect overall behaviors of care avoidance, which may explain why non-attenders demonstrated a higher risk of PCSM vs the control arm.
“It may be that men who opted not to attend a screening appointment are care avoiders, meaning they’re less likely to engage in healthy behaviors and preventative care in general. This is the opposite behavior of people who are perhaps more health conscious and are more likely to attend a screening appointment.”
The authors warn that non-attendance may be the greatest barrier to successful implementation of a population-based screening program. Thus, these data “emphasize the urgent need to address awareness, informed participation and inequalities in access,” the authors write.
“But it highlights a group of men who need our attention, as they’re more at risk of developing advanced prostate cancer and dying from it,” Nordström added. “We need to better understand why these men might actively choose not to participate in screening, despite being invited to attend, and how this behavior is linked to worse outcomes when they get a diagnosis.”
Full results from the ERSPC subanalysis are expected to be published later this year.
REFERENCES
1. Leenen RCA, Mulder E, Remmers S, et al. Prostate cancer mortality in men not attending a population-based screening program: The good, the bad, and the ugly after 20-year follow-up in the European Randomized study of Screening for Prostate Cancer. Presented at the 40th Annual European Association of Urology Congress. Madrid, Spain. March 21-24, 2025. Abstract A0279
2. Worse outcomes for men who avoid prostate cancer screening. News release. European Association of Urology. March 20, 2025. Accessed March 21, 2025. https://www.eurekalert.org/news-releases/1077327
