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Barriers to Action: the barriers that prevent men from finding their prostate cancer risk

A behavioural research study

Prostate cancer is the most common cancer in men. In the UK, 1 in 8 men will get prostate cancer in their lifetime; for Black men, this risk increases to 1 in 4 1. Despite this, there are several barriers that prevent men from engaging with prostate cancer risk information.

Our research aimed to uncover the scale of the barriers that prevent men from finding out their prostate cancer risk through the Risk Checker. Recognising and addressing these barriers can assist in shaping future messaging strategies to ensure that men have access to the necessary information for making an informed choice about prostate cancer.

Methods

The study was carried out online, using panel providers who have pools of pre-screened individuals who have voluntarily signed up to participate in surveys online. Surveys are sent to people who fit the right demographics, and they have the choice of whether or not to take part. They are offered a small compensation for completion of the survey, though they’re free to drop out at any point.

In order to identify the potential barriers (attitudes, beliefs, and conditions) that could be preventing men from engaging with prostate cancer risk, we reviewed the existing literature and consulted clinicians as well as men with lived experience.  We identified 35 statements associated with these potential barriers which were tested in our survey.

Within the analysis we wanted to understand prevalence of these barriers in men at risk of prostate cancer and derive the impact of these attitudes on risk checking behaviour, rather than explicitly asking what prevents people from checking their risk.

As a behavioural test we offered people the opportunity to take our Risk Checker once they had completed the survey.

To understand the impact of the attitudes on the behaviour we used a type of regression to understand overall impact on decision to act (i.e. check or not check risk). We used “Johnson’s Relative Weight Analysis” as described in: Johnson, J.W. (2000). A heuristic method for estimating the relative weight of predictor variables in multiple regression2.

Results

1,300 men participated in the study. Among them, 300 were Black men aged 45-70.

There were 992 men aged 50-70 who had not checked their prostate cancer risk. The results below are reported based on this representative sample of men.

When asked towards the start of the survey if they would like to be taken to the Prostate Cancer UK 30-second online Risk Checker after the survey, of the 922 men who didn’t know their risk 41% said they wanted to take it, 44% said they might want to take it and 15% said they were not interested.

46% of the 992 men aged 50-70 who had not checked their risk thought that they needed to have a digital rectal exam (DRE) to get tested for prostate cancer.  This belief was linked to lower likelihood of checking for prostate cancer risk and was one of the biggest factors preventing men from taking action. Interestingly, this barrier was weakly held. Once informed that a simple blood test is the best method for diagnosing prostate cancer and that DRE is not required, 71% no longer viewed DRE as necessary for diagnosis.

7 in 10 of the men said they’d wait until symptoms of any illness got really bad before visiting their GP, but the tricky thing about diagnosing prostate cancer is it often has no symptoms, and changes in how you pee are common — they were experienced by half the men in our research.  

42% of men believe their GP will inform them if they should be concerned about prostate cancer, and 80% of men assumed prostate cancer tests were included in routine health check-ups, neither of which is true. Lack of trust in the healthcare system and viewing prostate cancer as a punishment were two factors associated with not taking action.

Conclusion

Our study uncovered several barriers that prevent men at high risk of prostate cancer from engaging with prostate cancer risk information. One notable misconception we identified is the belief that the DRE is a necessary test for prostate cancer, despite evidence showing that the DRE is not a useful test for diagnosing prostate cancer3.

These findings highlight the importance of addressing the common barriers and misconceptions that prevent men from checking their prostate cancer risk. This is essential to ensure all men at risk access the information they need to make an informed choice about prostate cancer and the PSA blood test.

  1. Lloyd, Therese, et al. "Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008–2010." BMC medicine 13 (2015): 1-10.
  2. Johnson, Jeff W. "A heuristic method for estimating the relative weight of predictor variables in multiple regression." Multivariate behavioral research 35.1 (2000): 1-19.
  3. Kirby, Mike, et al. "Is the digital rectal exam any good as a prostate cancer screening test?." British Journal of General Practice 74.740 (2024): 137-139.