Shutao Hao1
Linlin Fang
Yanting Du- 1Department of Urology, Beijing Tongren Hospital, China Medical University (CMU), Beijing, China
- 2Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
- 3Department of Urology, The First Hospital of China Medical University, Shenyang, China
Purpose: To explore the factors influencing prostate cancer screening willingness among the Chinese male population.
Methods: This is a qualitative study that adopted a phenomenological approach. Purposive sampling was used to recruit 21 males (aged 48–81 years, with a mean age of ~57 years) from the health examination center of a tertiary hospital in Shenyang, China. Semi-structured face-to-face interviews were verbatim transcribed and independently cross-checked by two Master’s-level researchers. Data analysis was performed using MaxQDA ver.10 software and followed Colaizzi’s phenomenological analysis steps.
Results: Deductive analysis identified three core themes aligned with the Theory of Planned Behavior (TPB): Attitudes toward the Behavior (getting screened for the sake of family, primary prevention actions, meaningless, fear of the result, and don’t want family members to worry), subjective norm (family members, friends, and colleagues, and health professionals), and control beliefs (cost and insurance, limited understanding of the disease, no symptoms, unfamiliar with the PSA test, doubt screening, health examination package setting, and believe that cancer is incurable).
Conclusions: The study highlights the complex and unique factors influencing willingness to undergo prostate cancer screening in China. The findings provide insights for developing targeted interventions to address the challenges of insufficient prostate cancer screening, particularly by enhancing health professional guidance and addressing financial barriers.
1 Introduction
Prostate cancer (PCa) is the second most commonly diagnosed cancer and the fifth leading cause of cancer-associated mortality in men globally (1). Its incidence is rising worldwide, with decreasing mortality rates in developed countries but increasing rates in developing countries (1). In China, prostate cancer’s incidence and mortality rates are 9.8 per 100,000 and 4.22 per 100,000, respectively (2, 3), highlighting prostate cancer as a significant health threat to Chinese males.
Early detection of prostate cancer is crucial for effective treatment and improved survival rates (4, 5). However, prostate cancer is frequently diagnosed at an advanced stage due to the absence of early clinical symptoms (6). Screening methods primarily include prostate-specific antigen (PSA) testing, digital rectal examination (DRE), and transrectal ultrasound-guided biopsy (TRUS), with PSA testing being the most prevalent due to its 92.3% sensitivity (7) and mortality reduction of 20%-27% (8, 9). Despite these benefits, screening rates vary, with developed countries like European countries and the United States having rates of 72.2% (10) and 54% (11), respectively, while only 37.9% of Chinese males are aware of PSA testing (12). This disparity is attributed to limited public knowledge, uneven healthcare resources, and cultural barriers (13–15), resulting in many Chinese males being diagnosed at advanced stages and missing the optimal treatment window.
The Theory of Planned Behavior(TPB) is a well-established model (16) that has been widely applied to the prediction of behaviors (17–19). According to the TPB model (see Figure 1), an individual’s behavioral intention is the most immediate predictor of their actions, and this intention is influenced by three key factors: attitude, subjective norms, and perceived behavioral control (16). It has been extensively applied in studies of various health behaviors, including reproductive decisions (20) and cancer surveillance (21). It has greater explanatory power than other models such as the health model, and social cognitive theory (22, 23). Consequently, this study employed in-depth interviews based on the TPB framework to investigate the factors affecting prostate cancer screening among Chinese males aged 40 and older.
Figure 1. The theory of planned behavior (TPB) model.
While the TPB model is widely used in health behavior research, most studies have focused on Western populations, with limited qualitative research on Chinese males. Existing studies indicate that factors influencing prostate cancer screening are complex and varied, including individual health status, clinical symptoms, social relationships, demographic characteristics, and the knowledge of PSA screening (13–15). However, findings from these studies, which are predominantly based on Western populations, may not fully reflect the screening behaviors and influencing factors of Chinese males. Additionally, most research has employed quantitative methods, focusing on statistical analyses to explain screening behavior patterns, lacking in-depth exploration of the underlying social, cultural, and psychological mechanisms. This study aims to fill this gap by employing qualitative research methods based on the TPB model to examine attitudes, subjective norms, and perceived behavioral control regarding prostate cancer screening. By analyzing these factors, we seek to identify the main barriers and facilitators influencing prostate cancer screening behaviors among Chinese males.
2 Method
2.1 Study design and participants
This qualitative study adopted a phenomenological approach to explore the lived experiences and factors influencing prostate cancer screening willingness among Chinese males. The data collection was conducted from 3 March to 15 May 2021.
2.1.1 Sampling and sample size
Purposive sampling was used to recruit participants from the health examination center of a Tertiary A hospital in Shenyang, China. As is standard practice in qualitative research, data saturation was used to determine the final sample size. The data collection was terminated when no new topics appeared (24). Finally, 21 males were included in the study, with a mean age of approximately 57 years (range: 48–81 years). Respondents’ characteristics are presented in Table 1. The interviewees were aged between 48 and 81 years, with a mean age of approximately 57 years old. Nearly half held a bachelor’s degree or higher.
Table 1. Characteristics of participants (N = 21).
2.1.2 Inclusion and exclusion criteria
Inclusion criteria: 1) Aged 40 years or older (as prostate cancer screening guidelines indicate that routine PSA screening is not recommended for males younger than 40 years or those with a life expectancy of less than 10–15 years (25)); 2) Undergoing routine or pre-employment health screenings at the hospital.
Exclusion criteria: 1) History of prostate cancer; 2) Current diagnosis of prostate cancer; 3) Individuals seeking screening services independently.
2.2 Data collection
2.2.1 Instrument structure
The primary data collection instrument was a semi-structured interview outline (Table 1). The outline was developed based on the four core dimensions of the Theory of Planned Behavior (TPB): behavioral intention, subjective norms, perceived behavioral control, and attitude. The initial draft included 12 questions designed to probe beliefs and attitudes related to screening.
2.2.2 Instrument validity and credibility
To ensure the content validity of the interview guide, the initial outline was revised after consulting two nursing researchers and one urology clinician. This process ensured the questions were relevant to the clinical and theoretical focus. The final interview questions are presented in Table 2.
Table 2. The semi-structured interview form.
2.3 Procedures
Interview Setting and Data Gathering. Data were collected through semi-structured, face-to-face, in-depth interviews. Interviews were conducted by two trained authors. Chinese was the language of communication. Each interview was voice-recorded and lasted between 30 and 60 minutes (37 minutes minimum, 54 minutes maximum).
The interviews were conducted by two female authors, both Master’ s-level nursing researchers specializing in Urology. The gender difference between the interviewers and male participants warranted careful consideration, as some participants might have been reluctant to discuss sensitive, gender-specific health topics such as prostate cancer screening. However, the researchers’ positionality as female nursing specialists might have created a perceived neutral environment, which potentially encouraged male participants to express emotional or relational concerns (e.g., family worries) more openly. Their specialized urology research background provided expertise to probe deeply into related themes but was managed through strict adherence to the semi-structured interview guide to minimize the potential imposition of clinical judgment. All potential influences, including the interviewer–participant gender dynamic, were continuously examined during peer debriefing sessions to uphold methodological rigor.
2.4 Data analysis
To ensure data integrity and validity, all audio recordings were verbatim transcribed within 24 hours by a professional transcriber. Two researchers (with 2 years of qualitative data analysis experience) independently cross-checked the transcripts against the recordings, marking discrepancies and resolving them through joint review of the original audio - this process ensured a final error rate of <1%. Data were entered into MaxQDA ver.10 software, with a daily backup stored on a password-protected hospital research server and access restricted to 3 core team members.
Data analysis followed Colaizzi’s phenomenological analysis steps (26). This analysis included six steps: (1) Repeatedly listening to each recording and re-reading transcribed interview to gain a comprehensive understanding of each interviewee’s perspectives; (2) Extracting significant statements from the transcripts; (3) Assigning meaning to the extracted units; (4) Grouping similar units into categories, themes, and subthemes; (5) Providing comprehensive descriptions of the extracted categories; (6) Creating a basic paradigm of the subject under study based on the extracted categories.
2.5 Rigor and trustworthiness
Lincoln and Guba’s criteria (27) were used to evaluate the rigor and trustworthiness of this study. The rigor was established across the dimensions of credibility, dependability, and transferability.
2.5.1 Credibility
Credibility, or the confidence in the truth of the findings, was established through several techniques.
2.5.2 Investigator triangulation
The two interviewers, both master’s-level researchers specializing in Urology, independently verified the transcripts against the recordings and ensured consistency throughout the coding process. Consensus on coding and thematic classification was achieved within the core research team, thereby ensuring that the findings were not reliant on any single researcher’s interpretation.
2.5.3 Peer debriefing
The research team held regular debriefing sessions with an experienced qualitative researcher who was not directly involved in data collection. These sessions involved reviewing the coding frameworks, emerging themes, and potential researcher biases to critically examine underlying assumptions and interpretations, thereby providing external validation of the analytic process.
2.5.4 Clarification on member checking
The theoretical procedures of Colaizzi’s method include participant verification, commonly referred to as member checking. However, due to logistical constraints related to participant traceability within the health examination center context, formal member checking could not be performed. Consequently, neither complete transcripts nor summarized thematic results were returned to participants for validation. Instead, credibility was rigorously established through the combined strengths of investigator triangulation and peer debriefing.
2.5.5 Dependability, audit trail, and transferability
Dependability refers to the stability and consistency of findings over time and across researchers.
2.5.6 Audit trail
A comprehensive record of the research process was maintained throughout the study, including all voice recordings, transcripts, and field notes, thereby demonstrating the logical progression of the research.
2.5.7 Detailed methodology
A clear and comprehensive description of the data collection and analysis procedures, based on Colaizzi’s phenomenological steps, was documented to ensure methodological transparency.
2.5.8 Transferability
To enhance transferability, thick descriptions were provided of the methodology, study context (a tertiary A hospital in Shenyang, China, serving a diverse population), and participants’ characteristics (e.g., age, education, occupation), as detailed in Table 2. The findings section also incorporates numerous direct quotations to authentically represent participants’ voices.
2.6 Ethical considerations
This research was approved by the Medical Ethical Committee of The First Affiliated Hospital of China Medical University (Ref. 360/2020 on 4 January 2021). Prior to the interview, participants received information about the study’s aim and content, and informed consent was obtained from all participants. Participants were explicitly informed of their right to withdraw at any time without consequences, thus ensuring the voluntariness of their participation. To safeguard participant privacy and ensure anonymity, all participants were assigned identification codes (M1–M21). The corresponding audio recordings and transcripts were stored on a password-protected device with access limited to the core research team, thereby ensuring confidentiality. All study procedures involving human participants complied with the ethical standards of the institutional and national research committees and adhered to the 1964 Helsinki Declaration and its subsequent revisions (most recently, Brazil 2013).
3 Results
The thematic analysis revealed three core categories aligning with the Theory of Planned Behavior (TPB): Attitudes toward the Behavior, Subjective Norm, and Perceived Behavioral Control. These themes and their associated subthemes are summarized in Table 3 and illustrated in Figure 2.
Table 3. Thematic analysis: TPB category, themes, and exemplar supporting quotes on prostate cancer screening willingness among Chinese males.
Figure 2. Thematic Framework of factors influencing prostate cancer screening behavior among Chinese males (based on the Theory of Planned Behavior).
3.1 Attitudes toward the behavior
3.1.1 Beliefs in advantages
3.1.1.1 Getting screened for the sake of the family
Nine participants (9/21) take cancer screening as a part of family responsibility, as they believe that screening can help clarify their health conditions.
“At my age, the pressure is sort of maximized as I have a big family to support, hence I pay great attention to my health. I hope to diagnose any disease as early as possible.” [M19, 46, Bachelor’s degree, Accountant].
3.1.1.2 Primary prevention actions
Four participants (4/21) believed that prostate cancer screening is helpful, as early diagnosis of cancer leads to improved prognosis and reduced complications.
“Nowadays, medicine is advanced, and some cancers can be cured with the help of early diagnosis, so I think prostate cancer could be cured.” [M4, 65, Bachelor’s degree, Retirement].
“I haven’t had any health examination in the past two years, and this time I chose a package with a wide range of items, including cardiovascular and cerebrovascular ones, and tumor screening. After all, I am growing old.” [M17, 44, Associate’s degree, Self-employed].
“I choose different items every year according to my conditions. If there is any abnormality, I’ll go for further examination.” [M12, 50, Bachelor’s degree, Business management personnel].
3.1.2 Beliefs in disadvantages
3.1.2.1 Meaningless
Fifteen participants (15/21) believe cancer screening is meaningless because there is nothing to be done except waiting for death.
“All cancers were identified in the late stage … You can do nothing but wait for death.” [M10, 58, Bachelor’s degree, Business management personnel].
“I’m already 80 years old, and there’s no need for treatment even if cancer is detected … It would only make me anxious.” [M15, 81, Associate’s degree, Retirement].
3.1.2.2 Fear of the result
Twelve participants (12/21) fear being diagnosed with cancer, believing that avoiding screenings means they won’t have to face the reality of having cancer. This avoidance is often fueled by the observed psychological and financial distress that a cancer diagnosis causes others, which they use to rationalize their own preventative inaction.
“Many people, especially with those low payments, are scared of health examinations. Such a disease can cause serious psychological effects!” [M18, 52, Master’s degree, Engineer].
3.1.2.3 Don’t want family members to worry
Seventeen participants (17/21) avoided screening to prevent their family members from becoming concerned.
“I don’t want my children and relatives to receive information about my illness cause it will worry them about me.” [M15, 81, Associate’s degree, Retirement].
3.2 Subjective norm
Their subjective norms about screening Influences by significant others in the lives of the participants. The “significant others” were principally family members, friends, colleagues, and health professionals.
3.2.1 Normative beliefs -supportive
3.2.1.1 Family members
Among the participants, three males (3/21) who reported a family history of cancer were strongly aware of the impacts of cancer on their health and quality of life.
“My family has a history of cancer, so I take annual cancer screening.” [M20, 50, Bachelor’s degree, Self-employed].
“My brother died of prostate cancer, so my mother asked me to do it (prostate cancer screening).” [M17, 44, Associate’s degree, Self-employed].
3.2.1.2 Friends and colleagues
The attitudes and behavior of the males’ friends and colleagues also had an influence on their behavior. Three participants (3/21) indicated that the advice of peers would prompt them to consider screening.
“If your friends and colleagues are suffering from prostate cancer, you will follow their advice and take a screening.” [M8, 54, Bachelor’s degree, Civil servants].
3.2.1.3 Health professionals
Notably, five participants (5/21) emphasized that the health professionals at the hospital were the most authoritative and important influences on their intention for prostate cancer screening.
“If a doctor advises me to take a prostate cancer screening, I would not hesitate to take one.” [M2, 55, Associate’s degree, Business management personnel].
“Suggestions from friends or colleagues would have some influence. However, the doctor’s advice and my conditions would be determining.” [M6].
Despite these responses, most of the men interviewed in the present study reported that no-one had reminded them about the PSA testing.
“How are we supposed to know about this test? It is the doctor’s responsibility to inform us, but no one told me (about the likelihood of prostate issues).” [M6, 56, Bachelor’s degree, Business management personnel].
3.2.2 Normative beliefs -unsupportive
3.2.2.1 Colleagues
Three participants (3/21) reported that their colleagues held an unsupportive stance toward health check-ups, influencing their own skepticism.
“My coworkers said that health check-ups are a waste of money since they only catch serious illnesses, so what’s the point?” [M9, 63, Bachelor’s degree, Retirement].
3.3 Perceived behavioral control
3.3.1 Control beliefs -facilitators
3.3.1.1 An easy task
Four individuals (4/21) are willing to undergo screening because they find it acceptable and straightforward.
“Serum test of PSA? Just take a tube of blood. It’s acceptable for me.” [M4, 65, Bachelor’s degree, Retirement].
3.3.2 Control beliefs – barriers
3.3.2.1 Cost and insurance
In this study, ten participants (10/21), including both insured and uninsured individuals, expressed that cost and insurance were major obstacles.
“If the cost is reasonable and covered by medical insurance, I would like to undergo one.” [M3, 57, Master’s degree, Retirement].
“For prostate cancer screening, I believe that the acceptance of screening is related to personal awareness and cost.” [M6, 56, Bachelor’s degree, Business management personnel].
“Ordinary people can’t afford cancer screening at all (excitedly)!” [M14, 57, Primary school, Farmer].
“You don’t understand the mentality of the elderly. We would never go for a health examination unless it were free.” [M15, 81, Associate’s degree, Retirement].
3.3.2.2 Limited understanding of the disease
Seven participants (7/21) stated that they had never heard of prostate cancer. Limited information about prostate cancer in the media restricts their knowledge about prostate cancer and its screening.
“I often hear about breast cancer and cervical cancer on television, but prostate cancer is rarely mentioned. I don’t think most citizens are aware of or even notice this disease.” [M5, 48, Bachelor’s degree, Business management personnel].
“I am a regular listener to health radio, but there is little information about it (prostate cancer). I have heard about prostatitis and prostatic hyperplasia, though.” [M9, 63, Bachelor’s degree, Retirement].
“Prostate cancer is not as common as breast cancer or stomach cancer.” [M21, 58, Doctor’s degree, Professor].
3.3.2.3 No symptoms
For nine participants (9/21), the absence of symptoms leads them to avoid screening.
“I have some problems with the prostate. Although I am supposed to have a prostate cancer examination. I won’t do it actively because I don’t have any symptoms.” [M3, 57, Master’s degree, Retirement].
3.3.2.4 Unfamiliar with the PSA test
Fourteen participants (14/21) expressed a lack of understanding regarding the PSA test. Although most health examination centers have listed the serum PSA test as a diagnostic item for prostate cancer screening, few males notice this item, let alone fully understand it.
“The health examination package provided by the company usually includes abdominal color Doppler ultrasound examination, which should be able to detect prostate problems.” [M1, 54, High school, Self-employed].
“The risks of the PSA test are a bit confusing for me, because I have undergone blood tests for other items without any reported problems.” [M3, 57, Master’s degree, Retirement].
“I have done a full PET-CT, and the reports are normal, so I don’t know why I have to do prostate cancer screening.” [M16, 63, Junior high school, Self-employed].
3.3.2.5 Doubt screening
Eleven participants (11/21) are skeptical about the effectiveness of screening. They argue that many health examinations, including prostate cancer screenings, may be mere formalities with low diagnostic value.
“Many health examinations are merely a formality, and the likelihood of diagnosing a disease is quite low.” [M5, 48, Bachelor’s degree, Business management personnel].
“Some health examination results are highly predictable, such as atherosclerosis, but when it comes to prostate cancer … I’m afraid not.” [M13, 76, Secondary vocational school, Carpenter].
3.3.2.6 Health examination package setting
Indeed, nine participants (9/21) claimed that cancer screenings should be included in the health examination package.
“Health examinations provided by our companies are standardized. Fortunately, the female package includes a gynecological examination. Therefore, the male package should also include a prostate cancer screening.” [M2, 55, Associate’s degree, Business management personnel].
3.3.2.7 Believe that cancer is incurable
Twelve participants (12/21) perceive cancer as formidable, perceiving its treatment process as arduous and with limited prognostic benefits in terms of life extension.
“Getting cancer means waiting for death. What’s the point of getting any tests?” [M10, 58, Bachelor’s degree, Business management personnel].
4 Discussion
Prostate cancer represents a major health challenge for males worldwide, with early screening playing a critical role in reducing mortality and improving diagnostic and treatment outcomes (28). The findings of this study indicate a general lack of awareness about prostate cancer screening among Chinese males. This lack of awareness is reflected in skepticism about the utility of screening, concerns about potential results, and a negative perception of cancer. Over half of the sample (12/21) perceived cancer as incurable, directly contributing to the skepticism. This is consistent with findings from several studies. This is consistent with findings from several studies (29, 30). Furthermore, there is a significant gap in knowledge regarding Prostate-Specific Antigen (PSA) testing among Chinese males, which adversely affects their willingness to participate in screening programs. This knowledge gap is evidenced by the fact that 14 participants (14/21) expressed unfamiliarity with the PSA test. Contributing factors include educational and economic barriers that limit understanding of the benefits of cancer screening (31, 32). In contrast, Western countries generally emphasize the importance of early detection and treatment, supported by comprehensive insurance systems that mitigate financial barriers and enhance public education about screening practices (33). These approaches contribute to higher participation rates and improved health outcomes (34).
This study highlights several key factors influencing Chinese males’ willingness to undergo prostate cancer screening, including social support, economic status, awareness, health literacy, and insurance coverage. These elements create a complex decision-making landscape that impacts screening participation. Social support plays a crucial role, as attitudes and recommendations from family, friends, colleagues, and healthcare professionals significantly affect males’ screening decisions. Men with a family history of cancer often view screening more positively, though concerns about causing emotional stress to their families if diagnosed with cancer also arise. This dual role of social support, especially within the Chinese cultural context, underscores the importance of family in decision-making. Notably, five participants (5/21) specifically cited healthcare professionals as the most authoritative influence on their screening intention. As Rezaei et al. (35)suggested, enhancing health education for both patients and their families can improve screening attitudes and knowledge. Thus, leveraging social support from families, peers, and healthcare professionals is vital for encouraging early screening among high-risk populations.
Economic factors, including screening costs and insurance coverage, significantly impact the willingness to undergo prostate cancer screening. Ten participants (10/21), representing nearly half of the sample, viewed prostate cancer screening as costly and indicated a higher willingness to participate if the expenses were covered by health insurance. Currently, most health insurance plans in China do not cover prostate cancer screening, adding a financial burden and limiting access to screening (36). This economic pressure is particularly pronounced among elderly males, who often feel they will not participate unless the screening is free. This lack of coverage, combined with the finding that nine participants (9/21) noted the PSA test’s omission from standard health packages, suggests major systemic barriers to access. Smith et al. (15)found similar results, highlighting the need to target elderly populations for increased screening awareness. In contrast, in economically developed countries, screening costs are frequently covered by government or insurance programs, improving accessibility. To enhance participation among low-income and elderly groups, policymakers should consider incorporating prostate cancer screening into routine health check-ups and ensuring insurance coverage through targeted policy interventions.
Lack of awareness and low health literacy are significant factors contributing to the low participation rate in prostate cancer screening among Chinese males. Seven participants (7/21) reported limited knowledge about prostate cancer, and 11 participants (11/21) expressed active doubt about the effectiveness of screening, equating a diagnosis with a death sentence. This fear and misunderstanding highlight the need for better public education on prostate cancer in China (35). Additionally, a high proportion of respondents (14/21) indicated that they had never heard of PSA testing. This lack of awareness not only impacts understanding of prostate cancer screening but also causes many males to overlook this crucial test during their regular health check-ups. Enhancing health literacy can improve participation in cancer screening (37), as studies show that individuals with higher health literacy are more likely to engage in screening programs, leading to reduced cancer mortality rates (37, 38). Therefore, future efforts in screening and early diagnosis should prioritize enhancing public awareness of the “three early” concepts (early detection, early diagnosis, and early treatment) (39). This can be achieved by developing cancer screening education platforms and organizing awareness campaigns to improve self-awareness of early detection among high-risk groups, ultimately promoting changes in preventive behaviors (40).
5 Strengths and limitations
This study provides several notable strengths. Methodologically, the use of Colaizzi’s phenomenological approach allowed for an in-depth, rich exploration of the complex factors influencing prostate cancer screening willingness among Chinese males. Furthermore, the study is theoretically grounded, utilizing the Theory of Planned Behavior (TPB) framework to systematically identify the underlying psychological, social, and control factors. Critically, it addresses a significant research gap by focusing specifically on the unique context of Chinese males, where existing literature is scarce. However, several limitations should be acknowledged. Primarily, the small sample size (n=21), despite achieving data saturation, restricts the generalizability of the findings, preventing them from being fully representative of a broader Chinese male population. Furthermore, the recruitment site, a single tertiary hospital’s health examination center, introduces a potential selection bias, as participants’ views may not fully reflect those of males who have never undergone a health check-up. Beyond these sample limitations, the qualitative nature of the study meant that there was no standardized protocol or patient outcome data collected, limiting the ability to draw causal conclusions. The design also did not include an exploration of the specific reasons behind certain deficiencies (e.g., why health professionals do not routinely prompt screening), which warrants further investigation. Future research should involve a larger and more diverse sample from different socioeconomic backgrounds to improve generalizability and external validity.
6 Conclusions
In summary, this study revealed several factors that influence Chinese males’ willingness to undergo prostate cancer screening, including social support, economic level, lack of awareness, screening costs, and insurance coverage. While some factors are common across countries, China’s unique social, cultural, and healthcare contexts pose specific challenges. These insights suggest that tailored interventions, considering the distinct social, economic, and cultural conditions of various regions, are essential for improving global participation in prostate cancer screening and promoting early detection and treatment.
6.1 Clinical implications
The study suggests that medical institutions should regularly promote prostate cancer prevention and that health examiners should actively serve as educators before and after screening. Health examination centers should enhance risk assessment and support for key screening targets. Additionally, insurance reimbursement for cancer screening can increase participation in China. To standardize screening, community-based early detection through a national multi-center study and a comprehensive management plan for high-risk groups are recommended, along with establishing a nationwide prostate cancer database.
Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
Ethics statement
The studies involving humans were approved bythe Medical Ethical Committee of the First Affiliated Hospital of China Medical University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
SH: Writing – original draft. LF: Writing – original draft. YD: Writing – review & editing, Data curation. JZ: Writing – review & editing. YO: Writing – review & editing. ZY: Writing – review & editing.
Funding
The author(s) declared that financial support was not received for this work and/or its publication.
Acknowledgments
We would like to profoundly acknowledge the research participants in this study.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declare that no Generative AI was used in the creation of this manuscript.
Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A, et al. Global cancer statistics, 2012. CA Cancer J Clin. (2015) 65:87–108. doi: 10.3322/caac.21262
2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. (2018) 68:394–424. doi: 10.3322/caac.21492
3. Chen W, Sun K, Zheng R, Zeng H, Zhang S, Xia C, et al. Cancer incidence and mortality in China, 2014. Chin J Cancer Res. (2018) 30:1. doi: 10.21147/j.issn.1000-9604.2018.01.01
4. Culp MB, Soerjomataram I, Efstathiou JA, Bray F, and Jemal A. Recent global patterns in prostate cancer incidence and mortality rates. Eur Urol. (2020) 77:38–52. doi: 10.1016/j.eururo.2019.08.005
5. Pinsky PF and Parnes H. Screening for prostate cancer. N Engl J Med. (2023) 388:1405–14. doi: 10.1056/NEJMcp2209151
6. Tewari AK, Whelan P, and Graham JD. Prostate cancer: diagnosis and clinical management. Hoboken, NJ, USA: John Wiley & Sons (2013).
7. Liang H, Wang X, Li F, Xie Y, Shen J, Wang X, et al. Label-free plasmonic metasensing of PSA and exosomes in serum for rapid high-sensitivity diagnosis of early prostate cancer. Biosens Bioelectron. (2023) 235:115380. doi: 10.1016/j.bios.2023.115380
8. Hugosson J, Roobol MJ, Månsson M, Tammela TLJ, Zappa M, Nelen V, et al. A 16-yr follow-up of the european randomized study of screening for prostate cancer. Eur Urol. (2019) 76:43–51. doi: 10.1016/j.eururo.2019.02.009
9. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Zappa M, Nelen V, et al. Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet. (2014) 384:2027–35. doi: 10.1016/s0140-6736(14)60525-0
10. Morlando M, Pelullo CP, and Di Giuseppe G. Prostate cancer screening: Knowledge, attitudes and practices in a sample of men in Italy. A survey. PloS One. (2017) 12:e0186332. doi: 10.1371/journal.pone.0186332
11. Sirovich BE, Schwartz LM, and Woloshin S. Screening men for prostate and colorectal cancer in the United States: does practice reflect the evidence? Jama. (2003) 289:1414–20. doi: 10.1001/jama.289.11.1414
12. Wang Y, Xiao M, Zhang Y, Hong Z, Zhang R, Xu Q, et al. Investigation of awareness rate of prostate-specific antigen (PSA) among the general public in China and analysis of influencing factors. Front Public Health. (2023) 11:1080800. doi: 10.3389/fpubh.2023.1080800
13. Enaworu OU and Khutan R. Factors influencing Nigerian men’s decision to undergo prostate specific antigen testing. Afr Health Sci. (2016) 16:524–32. doi: 10.4314/ahs.v16i2.21
14. Dickey SL, Cormier EM, Whyte J, Graven L, and Ralston PA. Demographic, social support, and community differences in predictors of african-american and white men receiving prostate cancer screening in the United States. Public Health Nurs. (2016) 33:483–92. doi: 10.1111/phn.12245
15. Smith J, Dodd RH, Gainey KM, Naganathan V, Cvejic E, Jansen J, et al. Patient-reported factors associated with older adults’ Cancer screening decision-making: A systematic review. JAMA Netw Open. (2021) 4:e2133406. doi: 10.1001/jamanetworkopen.2021.33406
16. Ajzen I. The theory of planned behavior. Org Behav Hum Decision Proc. (1991) 50:179–211. doi: 10.1016/0749-5978
17. Le Bonniec A, Gourlan M, Préau M, and Cousson-Gélie F. Action Control of Colorectal Cancer Screening Participation with fecal immunochemical test (FIT). Int J Behav Med. (2022) 29:122–30. doi: 10.1007/s12529-021-09976-y
18. Khani Jeihooni A, Jormand H, and Harsini PA. The effect of educational program based on beliefs, subjective norms and perceived behavior control on doing pap-smear test in sample of Iranian women. BMC Womens Health. (2021) 21:290. doi: 10.1186/s12905-021-01419-w
19. Hyde MK, Opozda M, Laurie K, Vincent AD, Oliffe JL, Nelson CJ, et al. Men’s sexual help-seeking and care needs after radical prostatectomy or other non-hormonal, active prostate cancer treatments. Support Care Cancer. (2021) 29:2699–711. doi: 10.1007/s00520-020-05775-5
20. Sahraei M, Kohan S, Mohebbi-Dehnavi Z, and AbdiShahshahani M. The effect of single-child couples’ education based on the theory of planned behavior on their intention to have next child. J Educ Health Promot. (2024) 13:183. doi: 10.4103/jehp.jehp_505_23
21. Mirzaei-Alavijeh M, Amini M, Moradinazar M, Eivazi M, and Jalilian F. Disparity in cognitive factors related to cancer screening uptake based on the theory of planned behavior. BMC Cancer. (2024) 24:845. doi: 10.1186/s12885-024-12607-w
22. Gerend MA and Shepherd JE. Predicting human papillomavirus vaccine uptake in young adult women: comparing the health belief model and theory of planned behavior. Ann Behav Med. (2012) 44:171–80. doi: 10.1007/s12160-012-9366-5
23. Webb TL, Joseph J, Yardley L, and Michie S. Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res. (2010) 12:e4. doi: 10.2196/jmir.1376
24. Guest G, Bunce A, and Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. (2006) 18:59–82. doi: 10.1177/1525822X05279903
25. Carter HB, Albertsen PC, Barry MJ, Etzioni R, Freedland SJ, Greene KL, et al. Early detection of prostate cancer: AUA Guideline. J Urol. (2013) 190:419–26. doi: 10.1016/j.juro.2013.04.119
26. Colaizzi PF. Psychological research as the phenomenologist views it. In: Existential phenomenological alternatives for psychology. New York, NY, USA: Oxford University Press Inc (1978).
27. Lincoln YS, Guba EG, and Pilotta JJ. Naturalistic Inquiry. Beverly Hills, CA, USA: Beverly Hills California (1985).
28. Dy GW, Gore JL, Forouzanfar MH, Naghavi M, and Fitzmaurice C. Global burden of urologic cancers, 1990–2013. Eur Urol. (2017) 71:437–46. doi: 10.1016/j.eururo.2016.10.008
29. Çolak S, Vural F, and Bilik Ö. Psychosocial problems experienced by prostate cancer patients and nursing approaches. DEUHFED. (2022) 15:233–9. doi: 10.46483/deuhfed.834041
30. Natuhwera G, Ellis P, Acuda SW, and Namukwaya E. ‘I got to understand what it means to be a cancer patient’: Qualitative evidence from health professional cancer patients and survivors. SAGE Open Med. (2022) 10:20503121221095942. doi: 10.1177/20503121221095942
31. He Z and Ke Y. Precision screening for esophageal squamous cell carcinoma in China. Chin J Cancer Res. (2020) 32:673. doi: 10.21147/j.issn.1000-9604.2020.06.01
32. Cao M, Li H, Sun D, He S, Yu Y, Li J, et al. Cancer screening in China: the current status, challenges, and suggestions. Cancer Lett. (2021) 506:120–7. doi: 10.1016/j.canlet.2021.02.017
33. Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, et al. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: Cancer J Clin. (2019) 69:184–210. doi: 10.3322/caac.21557
34. Monticciolo DL, Newell MS, Moy L, Lee CS, and Destounis SV. Breast cancer screening for women at higher-than-average risk: updated recommendations from the ACR. J Am Coll Radiol. (2023) 20:902–14. doi: 10.1016/j.jacr.2023.04.002
35. Rezaei H, Negarandeh R, Pasheypoor S, and Kazemnejad A. Effect of educational program based on the theory of planned behavior on prostate cancer screening: A randomized clinical trial. Int J Prev Med. (2020) 11:146. doi: 10.4103/ijpvm
36. Ilic D, Neuberger MM, Djulbegovic M, and Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev. (2013) 2013(1):CD004720. doi: 10.1002/14651858.CD004720.pub3
37. Abasi B, Farahaninia M, Hasanpoor SB, and Haghani H. Health literacy and men’s attitudes and practices toward prostate cancer screening. J Client-Centered Nurs Care. (2019) 5:87–96. doi: 10.32598/JCCNC.5.2.87
38. Rutan MC, Sammon JD, Nguyen DD, Kilbridge KL, Herzog P, Trinh QD, et al. The relationship between health literacy and nonrecommended cancer screening. Am J Prev Med. (2021) 60:e69–72. doi: 10.1016/j.amepre.2020.08.018
39. Tollan K, Jezrawi R, Underwood K, and Janus M. A review on early intervention systems. Curr Dev Disord Rep. (2023) 10:147–53. doi: 10.1007/s40474-023-00274-8
Keywords: prostate cancer screening, theory of planned behavior, intention, behavior, qualitative study
Citation: Hao S, Fang L, Du Y, Zheng J, Ou Y and Yu Z (2025) Attitudes and intentions toward prostate cancer screening among males in China: a qualitative study. Front. Urol. 5:1698789. doi: 10.3389/fruro.2025.1698789
Received: 04 September 2025; Accepted: 21 November 2025; Revised: 12 November 2025;
Published: 09 December 2025.
Edited by:
Ruben Blachman-Braun, National Cancer Institute Bethesda, United StatesReviewed by:
Nina Mendez-Dominguez, Hospital Regional de Alta Especialidad de la Península de Yucatan IMSS-BIENESTAR, MexicoHaider Mohammed Majeed, University of Baghdad, Iraq
Arsen Davitadze, ITMO University, Russia
Copyright © 2025 Hao, Fang, Du, Zheng, Ou and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yanting Du, ZHUueWFudGluZzFAenMtaG9zcGl0YWwuc2guY24=