Why do men refuse or attend population-based screening for prostate cancer?

Background The aims of this study were to investigate the motives for refus ing or attending population-based screening for prostate cancer, in relatio n to various background characteristics. Methods The present study is part of the European Randomized Study of Scree ning for Prostate Cancer (ERSPC), and took place in 1995-1996. Men aged 55- 75 years were invited using the Rotterdam population registry (100 per cent coverage), of whom 42 per cent gave written informed consent. These men we re randomized to receive either determination of prostate specific antigen (PSA), digital rectal examination (DRE), transrectal ultrasound (TRUS) and biopsy on indication (screening group), or no screening (control group). To 626 consecutive men of the screening group a questionnaire was sent before the screening. To 500 randomly selected refusers (no written informed cons ent) a similar questionnaire was sent, followed by two reminders. In both r efusers and attenders we addressed motives, knowledge of prostate cancer, a ttitudes towards screening, background characteristics and urological compl aints (American Urological Association symptom index, AUA7). Results Response rates for questionnaires were 48 per cent in refusers and 99 per cent in attenders. Main reported motives for refusing were absence o f urological complaints (57 per cent) and anticipated pain or discomfort (1 8 per cent). Main reported motives for attending were personal benefit (82 per cent), contribution to science (49 per cent) and presence of urological complaints (25 per cent). Compared with attenders, refusers were slightly and significantly older, less often married and had a lower level of educat ion; they had less knowledge about prostate cancer and a less positive atti tude towards screening; they had worse general health but fewer urological complaints (AUA7 median 2 versus 4, p < 0.001). Conclusion In refusing or attending population-based prostate cancer screen ing, urological complaints but also knowledge, attitudes and sociodemograph ic factors seem to play a role. Therefore, the approach of the general popu lation should be carefully considered.