Perspectives on prostate cancer screening with PSA – a focus group study with men in Norway aged 54–85 years

Prostate cancer is the second most commonly diagnosed cancer worldwide, leading the European Commission to suggest prostate cancer screening with prostate specific antigen (PSA) as part of their policy for more and better screening. Screening with PSA is, however, contested due to ambiguous evidence of whether benefits outweigh negative consequences. Treatment may cause incontinence and impotence, potentially threatening masculinity. Learning that one is at risk for prostate cancer could instigate a sense of vulnerability among men who are eligible for screening. The uncertainty associated with screening with PSA, combined with the threat to masculinity, would potentially stop men from participating. Therefore, the current study aims to investigate perspectives that men in Norway have on prostate cancer screening before it is implemented as a national screening programme. Our study encompassed 10 focus groups with 48 men aged 54–85 in Norway. Seven groups included men diagnosed with prostate cancer. Data were analysed with reflexive thematic analysis. We identified two main themes: 1) Prostate cancer screening was beneficial despite uncertainties, and 2) Organized screening with PSA made threats to masculinity acceptable. Participants were positive towards screening because they saw early detection as beneficial. The simplicity of screening through a blood test concealed the complexity of the screening outcome and its consequences. Having an organised screening programme for prostate cancer appeared to our focus group participants as an opportunity enabling men to take care of their health without jeopardising their masculinity.