Men avoiding prostate cancer screening 45% more likely to die from disease

By Stephen Beech

Men who consistently avoid prostate cancer screening appointments are 45% more likely to die from the disease, warns new research.

Prostate cancer is the most common form of cancer in men in 112 countries, with cases expected to double by 2040.

But scientists say that, if introduced on a national scale, screening programs that measure levels of prostate-specific antigen (PSA) in the blood have the potential to give men earlier access to treatment, and a better chance of being cured.

But screening can also prevent costly treatment associated with advanced prostate cancer, according to data from the European Randomised Study of Screening for Prostate Cancer (ERSPC).

It collects information from seven European nations - Finland, the Netherlands, Italy, Sweden, Switzerland, Belgium and Spain - and is the world’s largest prostate cancer screening study.

Long-term data from the ERSPC consistently report that PSA screening programs can lead to a 20% reduced risk of dying from prostate cancer.

Now, an analysis of 20-year follow-up data from the ERSPC is the first to look at the link between consistently declining screening invitations and the risk of dying from prostate cancer.

It reveals a "stark contrast" that emphasizes the potential consequences of avoiding screening.

The analysis was led by researchers from Erasmus MC Cancer Institute at the University Medical Centre in The Netherlands.

Of 72,460 men invited to screening, around one in six were non-attenders and skipped every appointment.

That group had a 45% higher risk of dying from prostate cancer compared with those who attended screening appointments, according to the findings.

When comparing outcomes with the control group – men who were never invited to screening – men who attended screening appointments had a 23% lower risk of dying from prostate cancer, while non-attenders faced a 39% higher risk of death from the disease.

Study lead author Dr. Renée Leenen says that deciding not to participate in screening is a choice that may be driven by a complex mix of factors.

She said: “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.

“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."

Dr. Leenen added: "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.”

Dr. Tobias Nordström, of the Karolinska Institute, Sweden, said: "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 findings are due to be presented this weekend at the European Association of Urology (EAU) Congress in Madrid, Spain.