- 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.
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.
“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.
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.
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
