Skipping cancer screenings may contribute to a higher mortality rate from prostate cancer, new research suggests.
- Men who often miss their
prostate cancer screening appointments are much more likely to die from
the disease, according to new findings.
- The analysis, based on 20
years of data from over 160,000 men across seven European countries,
highlights a newly identified high-risk group often overlooked in national
screening efforts.
- Researchers say
understanding and addressing why some men avoid screening could be key to
improving survival rates and the overall success of future prostate cancer
screening programs.
Prostate
cancer is the most commonly diagnosed cancer among men in 112
countries, and its prevalence is projected to double by 2040.
Nationally implemented
screening programs that measure prostate-specific antigen (PSA) levels in the blood could
offer men earlier access to treatment, improving their chances of a cure and
reducing the need for expensive treatments linked to advanced-stage disease.
Long-term data
consistently show that PSA screening can lower the risk of dying from prostate
cancer by 20%.
In this new research,
from the world’s largest prostate cancer screening study, however, researchers
looked at 20 years of data to see how often saying no to prostate cancer
screening affects the chances of dying from the disease.
Based on 20 years of
data from over 160,000 men across seven European countries, the study
highlighted a high-risk group often overlooked in national screening efforts:
appointment avoiders.
The study’s findings showed that over 12,400 people
skipped their prostate screening appointments, leading to a 45% higher risk of
death from prostate cancer compared to those who did attend their screenings.
The findings were
presented at the European Association of Urology Congress 2025, March 21–24, in
Madrid, Spain.
Why men
avoid prostate cancer screenings
Choosing not to take
part in screening may stem from a complex combination of factors, according to
the study’s lead author, Renée Leenen,
MD, and PhD researcher in Professor Monique Roobol’s team at the Erasmus MC
Cancer Institute.
“The European Randomized study of
Screening for Prostate Cancer (ERSPC) was initiated in the
early 1990s to assess the effect of prostate-specific antigen (PSA)-based
screening on prostate cancer (PCa) mortality at a population level. In this
secondary analysis, we aimed to get insight into the risk of dying of PCa in
screening non-attenders using long-term data from the ERSPC,” Leenen told Medical
News Today.
“In the ERSPC, men were
randomized to either a screening arm (invited for screening/PSA test) or
control arm (not offered screening/PSA test),” Leenen continued.
“Of the 72,460 men
randomized to the SA, 12,401 (17%) did not attend any of the screening rounds
offered. We found that men who were offered screening (randomised to the
screening arm) but did not attend population-based screening (screening arm
non-attenders) are at 39% higher risk of dying from PCa compared to men that
were not offered screening (in the control arm).”— Renée Leenen, MD
“As a consequence,
non-attendance may be the biggest counteracting factor to the successful
implementation of population-based screening programs for (prostate) cancer,”
Leenen explained.
Nilesh Vora,
MD, board-certified hematologist and medical oncologist and medical
director of the MemorialCare Todd Cancer Institute at Long Beach Medical Center
in Long Beach, CA, not involved in this research, described these new findings
as “fascinating.”
LOWER DEATH RISK BY ATTENDING
SCREENINGS
“There has long been
controversy over whether PSA screening is helpful in a disease that we’ve long
labeled as ‘one that most patients will die with, rather than die from,’ but
this study seems to suggest a 23% decrease in mortality specifically from
prostate cancer in men who engage in screening.”— Nilesh Vora, MD
“The age of the
population at hand — 55-69 represents one that are candidates for aggressive
treatments if prostate cancer is found and thus, should be the target for
prostate cancer screening in future studies that could validate this trial,”
Vora noted.
Although these results are yet to be peer-reviewed,
Vora is looking forward to the full results being published later this year.
70% of the
population needs to be screened, says WHO
“For any screening program
to be effective, the World Health Organization (WHO) recommends that 70% of the
population needs to be exposed to the screening test,” Leenen pointed out.
“Nevertheless, current
cancer screening programs low and declining participation rates,” he noted.
Non-attendance may also
be one of the biggest counteracting factors when it comes to successful
screening for prostate cancer.
“We found that men who
were offered screening but did not attend population-based screening are at
higher risk of dying from PCa compared to men that were not offered screening.
Consequently, non-attendance may be the biggest counteracting factor to the
successful implementation of population-based screening programmes for
(prostate) cancer.”— Renée Leenen, MD
“Hence, there is an urgent
need for further qualitative research to explore screening non-attenders and
understand why, although being offered screening, they opted not to attend
population-based screening,” Leenen explained.
“This could inform
tailored intervention to address awareness, informed participation and
inequalities in access,” Dr. Leened added.
Why prostate
cancer screening rates were low
In 2012,
the U.S. Preventive Services Task Force discouraged people from undergoing
prostate-specific antigen (PSA)-based prostate cancer screening due to
overteratment and overdiagnosis from the years before. However, later data showed that lower screening rates were linked
to an increase in advanced cancers.
Ramkishen Narayanan, MD, board certified urologist and
urologic oncologist and Director of the Center for Urologic Health at The Roy
and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical
Center in Burbank, CA, who was also not involved told MNT, said
that “the European Randomized study of Screening for Prostate Cancer (ERSPC)
has been a touchstone for the importance of prostate cancer screening in the
U.S. for over 10 years now.”
“This updated study from
our European colleagues continues to highlight the importance of prostate
cancer screening in preventing prostate cancer-related deaths,” he said.
“The initial ERSPC study (Schröder et al., 2014)
informed us that if you perform a PSA screening blood test in about 1,000 men,
you will end up diagnosing and treating 37 men to prevent one prostate
cancer-related death,” Narayanan explained.
“Taken at face value
this may not appear very impressive and historically there was over-treatment
of prostate cancer in the U.S., specifically men diagnosed with low risk
prostate cancer getting surgery or radiation and ‘suffering in silence’ with
expected treatment effects on urination and sexual function,” Narayan said.
“The concern over
potentially unnecessary surgery or radiation led to an over-correction where
prostate cancer screening was discouraged in the U.S. from 2012 to 2017 by the
United States Preventive Services Task Force (USPSTF). We know that the
reduction in prostate cancer screening during that time period led to prostate
cancer getting diagnosed at higher grades and stages,” he continued.
“In this updated, ERSPC
study, the take-home point is that the over 12,000 men who effectively did not
follow any recommended screening guidelines, had a nearly a 40% higher risk of
death related to prostate cancer. The study reinforces the fact that prostate
cancer screening reduces the risk of dying from prostate cancer.”— Ramkishen
Narayanan, MD
“What is still left up
to interpretation is the best practical application of PSA screening for the
average man. The urologic community in the United States has adopted a shared
decision-making pathway with patients about prostate cancer screening, namely,
allowing patients to feel empowered to start and stop PSA screening with the
guidance of their trusted physician,” Narayanan noted.
WHY YOU SHOULDN’T SKIP A SCREENING
“Prostate cancer
screening trials and population-based screening programs/events were utilized
in the U.S. in the past but fell out of favor due to the undisciplined
management of results and subsequent treatment. In the contemporary era, where
patients are more informed to the point of being inundated with
recommendations, I believe the study here sends a clear signal through the
noise — ignoring prostate cancer screening will significantly increase a man’s
risk of dying from prostate cancer.”— Ramkishen Narayanan, MD.
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