At the 2025 Annual Meeting of the European Association of Urology (EAU), Professor Renée C.A. Leenen from Erasmus MC in Rotterdam, the Netherlands, presented the latest 20-year follow-up results from the European Randomized Study of Screening for Prostate Cancer (ERSPC). Her presentation focused on a specific subgroup within the trial: non-participants—men who were invited to undergo PSA-based screening but opted not to participate.This secondary analysis sheds new light on prostate cancer-specific mortality in this population and raises important questions about the design and implementation of screening programs—particularly when it comes to strategies for identifying and reaching high-risk groups.UroStream: You shared the long-term follow-up data of the prostate cancer screening study at the EAU conference. Could you please share the main findings? What implications does this study bring to clinical practice?
Dr. Renée C.A. Leenen: Thank you for interviewing me. My name is Renée Leenen. I’m a medical doctor working at Erasmus MC in Rotterdam, the Netherlands.I presented the 20-year follow-up outcomes of a secondary analysis we conducted within the ERSPC. This is a randomized, population-based trial that evaluates the effect of PSA-based screening on prostate cancer–specific mortality. The study began in the early 1990s, so we now have very mature data.
In this analysis, we specifically looked at men who were invited to undergo PSA screening but did not attend. We found that these non-attenders had a much higher risk of dying from prostate cancer compared to men in the control group, who were never offered screening at all. That’s a striking result. It tells us that non-attenders—despite being offered access to screening—are at particularly high risk. We believe this may be due to lower engagement in preventive healthcare, possibly influenced by factors like socioeconomic status.From a clinical perspective, this highlights the need to better understand who these men are and how to reach them. We know that participation rates in cancer screening are generally low and declining, and this study shows that the consequences of non-participation are very serious. We need better strategies to promote informed participation and make screening more accessible and equitable.
UroStream: Studies have shown that 17% of men in the screening group never participated in screening. What factors do you think may lead to the low participation rate in prostate cancer screening among this group of people?
Dr. Renée C.A. Leenen: Yes, and that’s important to address. The World Health Organization recommends a minimum 70% participation rate for screening programs to be effective. But in reality, even colorectal cancer screening programs in Europe have struggled to meet that target—only one member state has exceeded it. In contemporary prostate cancer screening trials, the rates are even lower.As for the reasons, there are a few possibilities. Some people suggest that declining trust in government or healthcare institutions could be playing a role. Others think that people may simply be less aware that screening is available, or that they should take part.For example, even breast cancer screening, which historically had high participation rates, is seeing a decline. So the issue may not be limited to prostate cancer —it may reflect a broader trend in public engagement with preventive health.
UroStream: Early screening and early diagnosis can improve the prostate cancer patients, especially the high-risk patients. Based on clinical experience, how do you think we can improve the screening compliance of the high-risk population?
Dr. Renée C.A. Leenen:It really starts with awareness. The men who are most at risk need to be informed that screening exists, that it’s relevant to them, and that early detection could significantly improve their outcomes. It’s not just about sending an invitation—it’s about making sure they understand why it matters, and that they feel supported in taking that step.
UroStream: Prostate cancer screening options are changing with each passing day. What do you think about the application of new biomarkers in prostate cancer screening?
Dr. Renée C.A. Leenen:It’s a very exciting area. There’s a lot of ongoing research and many new biomarkers are being discussed and developed. The ERSPC was based solely on PSA screening, where a high PSA level led directly to biopsy. We’ve seen that this reduces prostate cancer–specific mortality, but we also learned that a one-size-fits-all approach is not ideal. That’s why risk stratification is so important—and biomarkers can play a key role in that. They allow us to refine the screening process, reduce unnecessary biopsies, and better identify the men who truly need further investigation.
