"Prostate cancer screening is just a simple blood test" - how men in Norway view screening with PSA.


Marit Solbjør, Norwegian University of Science and Technology

Screening for cancer has been normalized through slogans as “early detection saves lives” and the implementation of screening programs. Prostate cancer is the second most common diagnosed cancer worldwide, but prostate cancer screening with prostate specific antigen (PSA) is contested due to ambiguous evidence of whether benefits outrun negative consequences. Its low specificity could lead to high numbers of men having a diagnosis and treatment for cancer that would not cause death, and treatment could cause incontinence and impotence. Regardless of this, an increasing number of countries are implementing PSA as a screening test, but not Norway, where urologists are critical towards such screening. Opportunistic screening is frequently done by men at their GPs’, and the Prostate Cancer Association is campaigning for a population program. Such variation of standpoints to prostate cancer screening led us to investigate the perspectives of men in Norway on screening with PSA. Theoretically, cancer screening can be understood as part of the biomedicalization regime (Clarke et al 2010), where techno-scientific developments, the focus on health risks and biomedical solutions result in practices of the body that contribute normalization of medical intervention on individuals without symptoms. Discourses of cancer prevention has been focused on breast cancer and women’s bodies as vulnerable. Learning that ageing male bodies are at risk for prostate cancer, could also lead to vulnerability, but this is in opposition to what has been termed hegemonic masculinity in our late modern western societies: denial of vulnerability, emotional and physical control, reluctance to seek help, and the interest in penetrative sex. Men can be reluctant to participate in screening for prostate cancer if they fear losing their masculinity. Thus, contradictory discourses frame men’s decision making about participation in prostate cancer screening. In the present study we did 10 focus groups with a total of 48 men in Norway, aged 54-85 years old. Seven groups were men diagnosed with prostate cancer. Data were analyzed with thematic analysis following Braun and Clarke (2022). The main theme that we identified was that routine prostate cancer screening is simple and necessary for normalizing PSA testing. This was comprised by three subthemes: the ambiguous PSA test is better than no screening for a cancer striking many men; the simplicity of a blood test shows the cost-benefit of having the PSA test; and a regular screening program can make men take care of their health without risking masculinity. The men were positive towards screening for prostate cancer with PSA because they saw early detection as beneficial. But, in their interpretation, since other men would not use health services regularly, having a screening program for prostate cancer was important. Knowledge about the uncertainty of PSA values and overdiagnosis did not influence views on the benefit of screening. The simplicity of screening through a blood sample obscured the complexity of PSA testing of non-symptomatic men. In conclusion, men who participated in our study were part of a pro-screening discourse that see early detection as beneficial despite weaknesses of current test practices. Such approaches to screening contribute to biomedicalization and individuals embracing surveillance medicine to act as responsible citizens.

This paper will be presented at the following session: