Motivations and Experiences of High-Risk Men in Risk-Adapted Prostate Cancer Early Detection: A Qualitative Study

Men with a family history of prostate cancer (PCa) or a pathogenic germline variant (PGV) face increased PCa risk. However, structured PCa early detection and insights into their experiences remain limited. This qualitative analysis explored (i) why men with familial or genetic PCa risk attended a risk-adapted prevention clinic, (ii) which clinical elements they found helpful, and (iii) how early detection services could be tailored to their needs. This study was part of the psychosocial mixed-methods study ProFam-Psych, run alongside the ProFam-Risk prevention clinic. Semi-structured interviews were conducted in a subgroup (13/84 study participants). The clinic offered PSA testing, mpMRI, genetic counselling and panel testing followed by risk-adapted recommendations. Participants were men without PCa who had a family history or previously detected PGV, and men with PCa who had a family history. Participants were selected using maximum variation sampling. Data were analysed by two researchers using Kuckartz’s qualitative content analysis. Seven motivators were identified: (1) clarify risk/PGV status, (2) information needs, (3) benefits for the family, (4) support others, (5) external recommendation, (6) access to structured screening, and (7) preventative recommendations. Participants with a family history were primarily motivated by (1) and (3), men with PGVs by (5) and (6), with (6) and (7) unique to this group. Perception of elements most helpful to participants varied, but the integrated setting with time for questions, clear guidance, and a reliable point of contact was valued. Suggested improvements were mostly organizational, including reminder systems to support long-term adherence. Interdisciplinary early detection for PCa was valued by participants, with motivators such as screening access and information needs highlighting the need for the implementation of structured screening programs for high-risk men. Results may inform future outreach efforts and design of screening strategies for familial and genetic PCa risk. DRKS.de, DRKS00032350. Prospectively registered with the German Clinical Trials Register (DRKS) on September 14th, 2023 Patient and User Perspectives and Characteristics • Participants with a family history of PCa mainly participated to gain clarity on their risk and mutation status, as well as for the potential benefit to their family. • Men with a Pathogenic-variant valued the free, structured early detection and often attended following external recommendation. • Participants proposed organizational improvements and wished for active follow-up outreach. • Findings refer to acceptability and diverse patient-motivators for risk-adapted early detection in familial and genetic PCa, supporting the need for implementation of risk-assessment and screening structures.