title: Why do men refuse or attend population-based screening for prostate cancer?
abstract: BACKGROUND
  The aims of this study were to investigate the motives for refusing or attending population-based screening for prostate cancer, in relation to various background characteristics.
  
  
  METHODS
  The present study is part of the European Randomized Study of Screening 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 were 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 consent) a similar questionnaire was sent, followed by two reminders. In both refusers and attenders we addressed motives, knowledge of prostate cancer, attitudes towards screening, background characteristics and urological complaints (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 of urological complaints (57 per cent) and anticipated pain or discomfort (18 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 education; they had less knowledge about prostate cancer and a less positive attitude towards screening; they had worse general health but fewer urological complaints (AUA7 median 2 versus 4, p < 0.001).
  
  
  CONCLUSIONS
  In refusing or attending population-based prostate cancer screening, urological complaints but also knowledge, attitudes and sociodemographic factors seem to play a role. Therefore, the approach of the general population should be carefully considered.
authors.affiliation: Department of Health Promotion, Municipal Health Services Rotterdam Area, The Netherlands. nijs@ggdzhz.nl
authors.forename: H G
authors.initials: HG
authors.lastname: Nijs
authors.forename: M L
authors.initials: ML
authors.lastname: Essink-Bot
authors.forename: H J
authors.initials: HJ
authors.lastname: DeKoning
authors.forename: W J
authors.initials: WJ
authors.lastname: Kirkels
authors.forename: F H
authors.initials: FH
authors.lastname: Schröder
mesh_terms: D000368:Aged; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016312:Treatment Refusal