Worry about prostate cancer and risk perception among middle-aged men: results from the PROBASE trial

Cancer worry and risk perception are relevant psychological factors that influence preventive health behaviors. Therefore, a thorough understanding of the factors that impact their occurrence and manifestation is critical. The objective of this study was to assess prevalence and factors associated with worry about prostate cancer (PCa) and absolute/comparative risk perception in a community-based sample of 45-year-old men. Data were collected within the German PCa screening trial PROBASE. Variables were assessed by self-report questionnaires and a clinical interview. Worry about PCa and absolute/comparative risk perception were assessed each on a 5-point-Likert scale. Multivariable logistic regression was used to identify factors associated with the outcomes of interest. Data were available for 33,476 (72.0%) of 46,495 men at enrollment. 7.3% had sometimes/(very) often worry about PCa. 3.7% and 9.9% perceived their absolute risk and comparative risk as somewhat high/very high and somewhat higher/much higher, respectively. 18.8% reported a positive PCa family history. Important factors of worry about PCa, absolute risk perception, and comparative risk perception were lower urinary tract symptoms (LUTS) (OR 3.00, 95% CI 2.63-3.42; OR 2.09, CI 1.71-2.56; OR 2.41, CI 2.10-2.76) and a positive PCa family history (OR 2.35, CI 2.08-2.65; OR 15.13, CI 12.73-17.97; OR 9.69, CI 8.76-10.72). A positive history of urological (OR 3.85, CI 2.63-5.63) and non-urological cancers (OR 1.97, CI 1.52-2.54) were associated with a higher comparative risk perception. In conclusion, worry about PCa and risk perception are influenced by non-cancer-related symptoms as well as by a positive PCa family history. These findings need to be addressed in risk communication with patients.