Consistently avoiding prostate cancer screening appointments increases the risk of dying from the disease, according to new research presented at the European Association of Urology (EAU) Congress in Madrid. The findings, based on long-term data from the world’s largest prostate cancer screening study, shed new light on the impact of screening behavior on patient outcomes.
The analysis draws on 20 years of follow-up from the European Randomized Study of Screening for Prostate Cancer (ERSPC), which has tracked more than 160,000 men across seven European countries. Among the 72,460 men who were invited to regular prostate-specific antigen (PSA) screening tests, around one in six – over 12,400 men – never attended a single appointment. This group had a 45 percent higher risk of dying from prostate cancer compared with those who participated in screenings.
In contrast, men who attended screening appointments had a 23 percent lower risk of death compared with a control group who were never invited. Men who declined screening, however, faced a 39 percent higher risk of dying than the control group – suggesting that choosing not to participate may carry more risk than not being offered screening at all.
Lead researcher Renée Leenen said the findings identify a new high-risk group. “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 behaviours and preventative care in general,” she said. “This is the opposite behavior of people who are perhaps more health conscious and are more likely to attend a screening appointment.”
Prostate cancer is the most common cancer in men across more than 100 countries. Screening programs using PSA blood tests can lead to earlier diagnosis, less aggressive treatment, and improved survival. However, uptake remains a challenge.
Tobias Nordström of the Karolinska Institute, Sweden, 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.”
The full results of this sub-analysis will be published later this year, as part of ongoing efforts to guide evidence-based, risk-adapted screening programmes across Europe through the EAU-led PRAISE-U initiative.
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