Men Who Skip Prostate Screenings Face a 45% Higher Risk of Death
Men who consistently avoid prostate cancer screening appointments face a much higher risk of dying from the disease, according to new research.
A massive 20-year study across seven countries reveals that non-attenders had a 45% higher mortality rate from prostate cancer than those who participated in screenings. Meanwhile, men who did attend screenings had a significantly lower risk of death. This highlights a crucial challenge: understanding why some men refuse screenings and how to encourage participation in future national programs to save more lives.
High-Risk Group Identified Among Screening Avoiders
Men who repeatedly skip prostate cancer screening appointments face a significantly higher risk of dying from the disease, according to new research that highlights an emerging high-risk group.
A large-scale analysis spanning seven countries, based on data from the European Randomized Study of Screening for Prostate Cancer (ERSPC), the world’s largest prostate cancer screening study, is being presented at the European Association of Urology (EAU) Congress in Madrid.
Prostate Cancer’s Growing Global Impact
Prostate cancer is the most common cancer among men in 112 countries, and its prevalence is expected to double by 2040. National screening programs that measure prostate-specific antigen (PSA) levels in the blood could provide earlier detection, improving treatment success rates and reducing the need for expensive interventions for advanced cases.
Long-term ERSPC data show that PSA screening programs can lower the risk of dying from prostate cancer by 20%.
The Deadly Consequences of Skipping Screening
Now, a sub-analysis of 20-year ERSPC follow-up data is the first to examine the impact of repeatedly declining screening invitations. The findings reveal a striking difference in outcomes, underscoring the risks of avoiding screening. This research was led by experts from the Department of Urology at Erasmus MC Cancer Institute, University Medical Center Rotterdam, in the Netherlands.
Of 72,460 men invited to screening, around one in six men (over 12,400) were non-attenders and skipped every appointment. This group had a 45% higher risk of dying from prostate cancer compared with those who attended screening appointments.
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.
Why Do Some Men Avoid Screening?
Deciding not to participate in screening is a choice that may be driven by a complex mix of factors, according to the study’s lead author, Renée Leenen MD, a PhD researcher in the group of Professor Monique Roobol at the Erasmus MC Cancer Institute.
“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.
Addressing Screening Avoidance for Better Outcomes
“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. 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.”
Through the EAU-led PRAISE-U project, several EU countries are working to align approaches to patient-tailored, risk-based population screening programs for prostate cancer. This latest research highlights the critical issue of attendance if national prostate cancer screening programs are to be successful, and the need to improve awareness and address inequalities in access to screening for this higher-risk group of men.
The Future of Prostate Cancer Screening Programs
The new analysis also suggests that the overall benefit of screening for prostate cancer is higher than previously thought, says Dr Tobias Nordström, Clinical Urologist at the Karolinska Institute in Sweden, and Member of the EAU Scientific Congress Office.
“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.
“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. 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 sub-analysis included 20-year follow-up data from 161,000 men aged 55-69 years in the ERSPC across Finland, the Netherlands, Italy, Sweden, Switzerland, Belgium, and Spain. The ERSPC was launched in 1990 across eight European countries, and the full results of this sub-analysis are expected to be published later this year.
“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” by Renée C.A. Leenen, Esmée Mulder, Sebastiaan Remmers et al is presented at EAU25 on Saturday, March 22, 2025.
Meeting: EAU25