Participation In Prostate Cancer Screening Research Articles

The importance of informing about the preventive program for early detection of prostate cancer- a preliminary pilot study

ObjectivesThe aim was to determine the knowledge of men about prostate cancer and screening methods, and the influence of these factors on participation in prostate cancer screening. Participants and methodsParticipants in this observational and cross-sectional study were men aged 40 to 79 years. Participation in the study was voluntary. Data were collected in May 2023 via an anonymous online survey. ResultsThere is a lack of knowledge about prostate cancer among men in Istria. Most receive information from the media, while a smaller number receive information from physicians. Most have heard that there is a PSA test, but few know that it is a method for early detection. Subjects have different perceptions of digital rectal examination and other screening methods. Some men are afraid of discomfort and pain during the examination, while others do not consider this a problem. Most indicate that they intend to participate in screening in the future and that early detection of prostate cancer is important and a positive attitude towards it influences the decision to participate in the screening program. ConclusionThe lack of knowledge about prostate cancer among men in Croatia is evident. Although most of the respondents do not consider themselves as a risk group, a positive attitude towards early detection affects the participation in prevention programs. Raising awareness and educating men about prostate cancer and available screening methods are key to increasing the number of participants in prevention programs and reducing the incidence of this disease.

Factors Influencing Prostate Cancer Screening Intentions in Lebanese Men.

The objective of this study is to investigate the perceived obstacles and willingness of Lebanese men aged 40 and above to undergo screening for prostate cancer. A cross-sectional research design was employed. The study utilized a survey questionnaire to collect data on various factors influencing screening behaviors. The research instrument consisted of a comprehensive survey questionnaire that incorporated validated scales to assess barriers to prostate cancer screening, intention to screen, and the International Prostate Symptom Score (IPSS). The study found that the 120 participants had an average IPSS score of 7.20 ± 2.23, most people (70%) had mild symptoms of prostate cancer, whereas others had moderate (20%) or severe symptoms (10%). The majority of the men indicated a low to moderate inclination to undergo screening through Prostate-specific antigen testing, or digital rectal examination (DRE) (PSA), with 76% considering DRE and 70% considering PSA. The main barriers to screening included the dread of receiving distressing outcomes (48%) and a lack of understanding about the screening procedure (54%). The study identified key factors affecting the intention to undergo a prostate cancer screening. Regarding DREs, these factors included the perceived danger of the illness and prior information from doctors about prostate conditions. When it came to the intention to undergo screening through the prostate-specific antigen test (PSA), determinants included the perceived threat of the disease, one's general health perception, and prior information from doctors about prostate-related issues. Additionally, a significant proportion of participants believed that prostate cancer was not a serious illness (56%) and 57% thought DRE was embarrassing. The participants displayed a low willingness to get screened for prostate cancer. Implementing interventions that focus on increasing awareness of the disease and its associated risks could potentially reduce the barriers and boost participation in prostate cancer screening.

Dépistage du cancer de la prostate en France : résultats des enquêtes EDIFICE

Prostate cancer (PCa) is the most common cancer amongst men in 2018 in Europe. The issue of PCa screening in the general population has been debated following the publication of international European (ERSPC) and North American (PLCO) studies. There is currently no organised PCa screening. The objective of this analysis was to evaluate the practice of PCa screening in the French population with no history of cancer between 2005 and 2016. Since 2005, the EDIFICE surveys have focused on the knowledge and behaviour of French people with regard to cancer screening. The practice of screening was evaluated according to the answer to the question: "Have you ever done PCa screening?" Responses were analysed according to age, socio-professional category and level of social precariousness. After a strong increase between 2005 and 2008 (from 36% to 49%, P≤0.01), a significant decrease in the reported PCa screening rate was observed between 2014 (49%) and 2016 (42%; P=0.02). This decrease was mainly reflected in the socially advantaged categories and in the youngest age group (50-54 years). Screening practices remain the same in older men. The perception of the effectiveness of PCa screening could explain the changes of behavior in the French population. This decrease in participation in PCa screening requires monitoring to avoid a general loss of confidence in cancer screening. 3.

Geographical Disparities in Screening and Cancer-Related Health Behaviour

This study aimed to identify whether cancer-related health behaviours including participation in cancer screening vary by geographic location in Australia. Data were obtained from the 2014–2015 Australian National Health Survey, a computer-assisted telephone interview that measured a range of health-related issues in a sample of randomly selected households. Chi-square tests and adjusted odds ratios from logistic regression models were computed to assess the association between residential location and cancer-related health behaviours including cancer screening participation, alcohol consumption, smoking, exercise, and fruit and vegetable intake, controlling for age, socio-economic status (SES), education, and place of birth. The findings show insufficient exercise, risky alcohol intake, meeting vegetable intake guidelines, and participation in cervical screening are more likely for those living in inner regional areas and in outer regional/remote areas compared with those living in major cities. Daily smoking and participation in prostate cancer screening were significantly higher for those living in outer regional/remote areas. While participation in cancer screening in Australia does not appear to be negatively impacted by regional or remote living, lifestyle behaviours associated with cancer incidence and mortality are poorer in regional and remote areas. Population-based interventions targeting health behaviour change may be an appropriate target for reducing geographical disparities in cancer outcomes.

A Survey of the Knowledge of African-American Women About Prostate Cancer Screening.

Prostate cancer is the second most common cancer diagnosed in men. Its incident and mortality rates are generally higher in populations of African descent. The scientific community recommends that men should be informed of the benefits, risks, and limitations of screening in order to make an informed decision regarding participation in prostate cancer screening. Women are known to act as the healthcare gatekeeper for the family. As such, African-American (AA) women could facilitate the informed decision-making process by providing prostate cancer and screening information to AA men. However, little is known about AA women's knowledge regarding prostate cancer and screening. This report describes the findings of a non-experimental cross-sectional study conducted using a convenience sample of 200 AA women. Data was collected using the knowledge subscale of the Eastland prostate cancer survey. Data was analyzed using JMP 13 statistical software developed by Statistical Analysis Systems (SAS) Institute. The overall mean knowledge score was 6.59 (47.1%). Knowledge was significantly associated with personal or family history of cancer (p=.02), family history of prostate cancer (p=.002), and the age of the respondents (p=.004) with those of older age (51years and above) scoring higher on the knowledge scale. The results indicated that the AA women had a low knowledge of prostate cancer and screening. The findings indicate the need to develop and implement prostate cancer educational programs that include AA women.

Abstract LB-359: Knowledge of prostate cancer and screening attitude of residents of a Nigerian community

Abstract This study assessed the level of awareness and knowledge of prostate cancer amongst the residents of a Nigerian University and its environs. A cross-sectional descriptive study using self-administered questionnaires was carried out among 443 people, aged 20 to 80 residing in Covenant University, Nigeria and its environs. Data analysis was done with SPSS version 15.0. The level of significance was set at p <0.05. The majority (45.1%) of respondents was aged between 31 - 40 years and only 41.3% were aware of the existence of Prostate cancer. Educational background, occupation and religion were observed to significantly increase (p <0.05) awareness of prostate cancer while gender and age did not. The awareness and previous participation in prostate cancer screening negatively (p <0.05) influenced respondents’ decision to participate in future screening. Electronic media via radio and television was the commonest source of awareness for prostate cancer. Only 13.4% became aware through health facility or personnel. Only 30.5% correctly identified the location of the prostate. Most of the respondents identified poor diet and environmental conditions as risk factors while 13.7%, 2.0% and 5.9% identified aging, race and genetics respectively as the causes of prostate cancer. Most of the respondents (31.2%) correctly identified difficult urination as a symptom of prostate cancer. About 30.8% have a relative, family or friend that had prostate cancer out of which 18.5% resulted in deaths. Only one respondent had been previously diagnosed with an enlarged prostate. Majority of the respondents were unaware of a possible cure or therapy. Only 9.9%, of the respondents strongly agreed that prostate cancer was peculiar to all men while a low percentage (4.1%) of respondents strongly agreed that it is a health disparity issue among black men. Over all a very low percentage of 37.9% of the respondents considered prostate cancer to be a serious ailment. The study showed a generally poor knowledge and wrong conceptions about prostate cancer, screening and treatment. This suggests the need for public health education and screening programs on prostate cancer for this population and others. Citation Format: Emeka E.J Iweala, Conrad A. Omonhinmin, Dominic E. Azuh, Isioma J. Okwudi. Knowledge of prostate cancer and screening attitude of residents of a Nigerian community. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-359.

Predictors of prostate cancer screening intention among older men in Jordan

ABSTRACTIntention to prostate cancer screening (PCS) is one of the major factors affecting the long‐term success of population‐based PCS programmes. The aim of this study is to explore strong factors linked to intention to PCS among older Jordanian adults using the Health Belief Model (HBM). Data were obtained from Jordanian older adults, aged 40 years and over, who visited a comprehensive health care centre within a ministry of health. A pilot test was conducted to investigate the internal consistency of the Champion Health Belief Model Scale for PCS and the clarity of survey questions. Sample characteristics and rates of participation in PCS were examined using means and frequencies. Important factors associated with intention to PCS were examined using bivariate correlation and standard multiple linear regression analysis. About 13% of the respondents were adherent to PCS over the prior decade. Four out of the seven HBM‐driven factors (perceived susceptibility, benefits and barriers to prostate‐specific antigen (PSA) test, and health motivation) were statistically significant. Those with greater levels of susceptibility, benefits of PSA test and health motivation and lower levels of barriers to PSA testing were having more intention to participate in PCS. Family history, presence of urinary symptoms, age and knowledge about prostate cancer significantly predicted the intention to PCS. Intervention programmes, which lower perceived barriers to PSA testing and increase susceptibility, benefits of PSA testing and health motivation, should be developed and implemented.

Predictors of Participation in Prostate Cancer Screening among Older Men in Jordan.

Participation is one of the major factors affecting the long-term success of population-based prostate cancer screening programs. The aim of this study was to explore strong factors linked to participation in prostate cancer screening among older Jordanian adults using the Health Belief Model (HBM). Data were obtained from Jordanian older adults, aged 40 years and over, who visited a comprehensive health care center within the Ministry of Health. A pilot test was conducted to investigate the internal consistency of the the Champion Health Belief Model Scale for prostate cancer screening and the clarity of survey questions. Sample characteristics and rates of participation in prostate cancer screening were examined using means and frequencies. Important factors associated with participation in prostate cancer screening were examined using bivariate correlation and multivariate logistic regression analysis. About 13% of the respondents had adhered to prostate cancer screening guidelines over the previous decade. Four out of the seven HBM-driven factors (perceived susceptibility, benefits and barriers to PSA test, and health motivation) were statistically significant. Those with greater levels of susceptibility, benefits of PSA test and health motivation and lower levels of barriers to PSA testing were more likely to participate in prostate cancer screening. Family history, presence of urinary symptoms, age, and knowledge about prostate cancer significantly predicted the participation in prostate cancer screening. Health professionals should focus more on the four modifiable HBM-related factors to encourage older adults to participate in prostate cancer screening. Intervention programs, which lower perceived barriers to PSA testing and increase susceptibility, benefits of PSA testing and health motivation, should be developed and implemented.

Determinants of participation in prostate cancer screening: a simple analytical framework to account for healthy-user bias.

In Japan at present, fecal occult blood testing (FOBT) is recommended for cancer screening while routine population-based prostate-specific antigen (PSA) screening is not. In future it may be necessary to increase participation in the former and decrease it in the latter. Our objectives were to explore determinants of PSA-screening participation while simultaneously taking into account factors associated with FOBT. Data were gathered from a cross-sectional study conducted with random sampling of 6191 adults in Osaka city in 2011. Of 3244 subjects (return rate 52.4%), 936 men aged 40–64 years were analyzed using log-binomial regression to explore factors related to PSA-screening participation within 1 year. Only responders for cancer screening, defined as men who participated in either FOBT or PSA-testing, were used as main study subjects. Men who were older (prevalence ratio [PR] [95% confidence interval (CI)] = 2.17 [1.43, 3.28] for 60–64 years compared with 40–49 years), had technical or junior college education (PR [95% CI] = 1.76 [1.19, 2.59] compared with men with high school or less) and followed doctors' recommendations (PR [95% CI] = 1.50 [1.00, 2.26]) were significantly more likely to have PSA-screening after multiple variable adjustment among cancer-screening responders. Attenuation in PR of hypothesized common factors was observed among cancer-screening responders compared with the usual approach (among total subjects). Using the analytical framework to account for healthy-user bias, we found three factors related to participation in PSA-screening with attenuated association of common factors. This approach may provide a more sophisticated interpretation of participation in various screenings with different levels of recommendation.

Abstract B105: Intake of heterocyclic aromatic amines and the risk of prostate cancer in the EPIC-Heidelberg cohort

Abstract Background: Heterocyclic amines are mutagens formed in meat prepared at high temperatures. These compounds are associated with prostate cancer risk in animal models. Because of mostly inconsistent results of the published studies it was the aim of this study to examine the association between intake of heterocyclic amines and the risk of prostate cancer in the EPIC-Heidelberg cohort study. Methods: Within the EPIC-Heidelberg cohort, detailed information on diet, anthropometry, and lifestyle was assessed between 1994 and 1998. Dietary HCA intake was assessed using information on amount of meat consumption, cooking methods, and degree of browing. After excluding men with prevalent cancer or with missing information on food preparation methods and preferred degree of browning our study population comprises a total of 9578 men (80.2% of the total cohort). Until July 31, 2009, 337 incident cases of prostate cancer have been identified. One-hundred twenty-three advanced prostate cancer cases, defined as Gleason sum score equal or higher than 7, TNM staging score of T3/T4, N1–N3, or M1 or prostate cancer as the underlying cause of death, were identified. Cox proportional hazards regression was used to examine the association between intake of 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), and 2-amino-3,4,8-dimethylimidazo[4,5-f]quinoxaline (DiMeIQx) and prostate cancer risk taking into account age, smoking status, participation in prostate cancer screening, family history of prostate cancer, and intake of milk and milk products. Results: Men in the highest quartiles of PhIP, MeIQx, and DiMeIQx intake, respectively, did not have an increased risk of prostate cancer compared with men in the lowest quartiles (HR=0.89, 95% CI 0.66–1.22 [PhIP]; 1.06, 0.77–1.45 [MeIQx]; 0.98, 0.72–1.34 [DiMeIQx]). There were also no indications of positive associations between HCA intake and risk of advanced prostate cancer (HR=0.89, 95% CI 0.51–1.56 [PhIP]; 0.91, 0.53–1.57 [MeIQx];1.05, 0.61–1.82 [DiMeIQx]). Further adjustment for other potential confounders did not materially modify these associations. In addition to HCAs, we also observed no association between high consumption of strongly browned meat and prostate cancer. Conclusions: Previous epidemiological studies on the association between HCA intake and prostate cancer risk have led to inconclusive results. Our data do not support the hypothesis that HCA intake as consumed in a regular diet is a risk factor for prostate cancer. Citation Information: Cancer Prev Res 2010;3(1 Suppl):B105.

Digital rectal examination is barrier to population-based prostate cancer screening

Objectives To determine whether use of the digital rectal examination (DRE) results in decreased participation in prostate cancer (PCa) screening, which, in turn, would result in lower detection. Population-based PCa screening includes prostate-specific antigen (PSA) measurement with or without a DRE. PSA and DRE screening provide greater sensitivity than PSA alone; however, the increased participation rate resulting from PSA-alone screening may result in a greater detection rate. Methods We performed a survey of 13,580 healthy men undergoing PSA-only population-based screening. In addition to the basic demographic information, the survey asked whether the participant would still be willing to participate in the screening if it included a DRE. We modeled the willingness to participate to assess the effect of PSA screening versus PSA and DRE screening on the basis of previously published data and our results. Results The results of our study indicated that only 78% of men would participate in screening that included both DRE and PSA. Thus, 7800 men of a theoretical population of 10,000 would participate in a screening that included both DRE and PSA. The positive screen rate (PSA ≥ 4.0 ng/mL and/or abnormal DRE) would then have been 2013, with 472 PCa cases and 1540 negative biopsies. In the PSA-alone arm, all 10,000 men would have agreed to participate, and the positive screen rate (PSA ≥ 4.0 ng/mL) would have been 1480, with 499 PCa cases and 980 negative biopsies. The PSA-alone arm would thus have detected 27 more cancers and performed 560 fewer negative biopsies. Conclusions The results of our study have demonstrated that DRE is a significant barrier to participation in PCa screening. PSA plus DRE-based programs result in fewer cases of PCa detected, with a significant increase in negative biopsies. We, therefore, suggest that future mass screening efforts include only PSA determination and omit the DRE.

Participation in prostate cancer screening among low-income men

Lower-income men are less likely to participate in prostate cancer screening and more likely to be diagnosed with advanced stages of prostate cancer which leads to poorer prognosis. Purposive sampling was used to recruit 1,887 men (21% with incomes less than $10,000 per year) from work sites, churches and housing projects to an educational programme and a subsequent free prostate cancer screening with their personal physician. In contrast to most studies which have significant decreased participation among low-income men, there were no significant differences in participation based on income for this cohort. Implications for recruitment of lower-income men into prostate cancer screening are cited.

Barriers to prostate cancer screening.

The revised prostate cancer screening guidelines of the American Cancer Society recommend that men be informed of the risks associated with prostate cancer screening. However, there are no published studies on men's fear of impotence and its impact on prostate cancer screening. In addition, little is known about barriers to prostate cancer screening when the two main barriers of cost and lack of knowledge are eliminated. This study reports the association between barriers and free prostate cancer screening after a prostate cancer education program. All men were called 1 month after a prostate cancer education program and asked: "What would (or did) make it hard for you to get your prostate checkup done?" A total postbarrier score was created to measure how many barriers each man indicated. The following barriers were significant in predicting participation in prostate cancer screening: "put it off," "doctor hours not convenient," "didn't know kind of doctor," "didn't know where to go," and "refuse to go." Fear of impotence was not a significant barrier. Suggestions for reducing barriers to prostate cancer screening are given.

DISEASE RECURRENCE IN BLACK AND WHITE MEN UNDERGOING RADICAL PROSTATECTOMY FOR CLINICAL STAGE T1-T2 PROSTATE CANCER

The reported incidence and mortality of prostate cancer are higher among black than white men. Reasons for the disproportionate racial incidence of this disease are not known but most surveys suggest that increased mortality among black men is due to more advanced tumor stage at diagnosis. To determine if racial differences exist in men with similar stage disease we compared disease recurrence in black and white men who underwent radical prostatectomy for clinical stage T1-T2 prostate cancer. We reviewed the records of all 257 white and 218 black men undergoing radical prostatectomy for clinical stage T1-T2 prostate cancer at the Louisiana State University Medical Center-Shreveport and the Overton-Brooks Veterans Affairs Medical Center between January 1990 and November 1998. Age, race, serum prostate specific antigen (PSA), ultrasound measured prostate volume, PSA density (PSA divided by prostate volume), histological features of the prostate biopsy, clinical stage, pathological stage, histological features of the radical prostatectomy specimen and disease recurrence were reviewed. Black men had significantly higher mean serum PSA and PSA density than white men (2-sided p = 0.005 and 0.03, respectively). There were no statistically significant differences by race in terms of patient age, prostate volume, clinical stage, biopsy Gleason score, pathological stage, positive pelvic lymph nodes, positive surgical margins or PSA recurrence rates. Black men with clinical stage T1-T2 prostate cancer who underwent radical prostatectomy had significantly higher serum PSA and PSA density than similarly treated white men. However, race appears to have no independent impact on pathological findings or disease recurrence in men with clinically localized prostate cancer treated with radical prostatectomy when the effects of differences in serum PSA are controlled.

Urinary symptoms as a predictor for participation in prostate cancer screening among African American men.

There are minimal data on the influence of urinary symptoms and participation in prostate cancer screening in African American men. This correlational study examined the influence of urinary symptoms on 1) participation in a free prostate cancer screening program and 2) abnormal screening results. The 1,402 African American men in the South Carolina Prostate Cancer Project (SCPCP), mean age of 50 years, completed a survey that included self-reported urinary symptoms, participated in a prostate cancer educational program, and received a free prostate cancer screening consisting of a digital rectal examination (DRE) and prostate-specific antigen (PSA) from their personal physician. One in 5 men reported the presence of urinary symptoms. Over 60% of the 1,402 men participated in the free CaP screening. Among the 852 men who participated in the free prostate cancer screening, 73 (8.6%) had abnormal screening results as classified by abnormal DRE and/or PSA >4.0 ng/ml. Urinary symptoms were significant predictors, both of participation in screening (OR = 1.30, CI = 1.00, 1.70) and of obtaining an abnormal screening result (OR = 1.78, CI = 1.17, 2.72). Prostate cancer health education needs to include the fact that prostate cancer, in its early stages, has no urinary symptoms.

Urinary symptoms as a predictor for participation in prostate cancer screening among African American men

Urinary symptoms as a predictor for participation in prostate cancer screening among African American men

Perceived benefits: a predictor of participation in prostate cancer screening.

Prostate cancer is the most frequently diagnosed major cancer and the second cause of cancer-related deaths among men. With early detection through screening and timely treatment, 9 out of 10 men will survive a minimum of 5 years. However, with late diagnoses, only 3 out of 10 men will have a 5-year minimum survival rate. Guided by a conceptual map, this correlational research examined perceived benefits as a predictor of participation in free prostate cancer screening. Perceived benefits are the personal belief and valuing of screening for early detection of prostate cancer. All subjects received one of four educational interventions: traditional, peer educator, client navigator, or combination. Participation in prostate cancer screening was measured by compliance with the American Cancer Society's Guidelines, which included a digital rectal exam (DRE) and/or a prostate-specific antigen (PSA) blood test. The purposive sample (n = 1,522) of men, ages 40 to 70 years, was recruited from randomly selected churches, barbershops, industries, housing projects, and car dealerships in a southeastern state. Seventy-two percent of the sample was African American. Predictors of participation in free prostate cancer screening were these: perceived benefits, being white, having at least a high school education, being married, and receiving the client navigator or combination educational intervention. The Benefits Scale was significant (p = 0.013, odds ratio (OR) = 1.059) as a predictor for participation in screening when all demographic variables and educational interventions were controlled. Practice implications for nursing are discussed and recommendations for future research are presented.

Predictors of Participation in Prostate Cancer Screening at Worksites

Unfortunately, African American men have a higher incidence of and a higher mortality rate for prostate cancer than White men but are less likely to participate in prostate cancer screening. This correlational survey research identifies predictors for participation in a free prostate cancer screening in 179 men, 64% of whom are African American. Each man was invited to see his personal physician for a free prostate cancer screening following a prostate cancer educational program given at his worksite. Forty-seven percent of the African American men went to their personal physician following the educational program and received a digital rectal examination (DRE) and a prostate specific antigen (PSA) screening. In the original cohort of educational program attendees, only 16% of the African Americans had obtained a DRE in the previous 12 months. However, 44% subsequently did participate in free DRE screening. Similarly, only 6% of the African American men had received a PSA screening in the previous 12 months, yet 42% obtained a PSA screening after the educational program, a sevenfold increase. Implications for allocating limited resources for education and screening to the high-risk group of African American men are discussed. This study's model of a prostate cancer educational program at worksites followed by attendees visiting their personal physician for screening could be replicated throughout the United States to increase African American men's participation in prostate cancer screening.

Recruitment of African Americans into prostate cancer screening.

Both incidence and mortality rates for prostate cancer are significantly higher in African American men than in white men. This report identifies community sites for the optimal recruitment of African American men into prostate cancer screening. A descriptive study was conducted, providing an educational program to 1369 African American men, 1264 of whom completed a survey on demographic data, prostate cancer knowledge, and prostate cancer screening history. The programs were offered at six different types of community sites, including various work sites, churches, housing projects, National Association for Advancement of Colored Persons (NAACP) sites, barber shops, and a state fairground. Free prostate cancer screening was offered to all participants. The advertised mass screening site (state fairground), the most common method used nationally to recruit African American men for cancer screening, was the least effective site, with only 16 men completing the survey. Of the 1264 men completing the survey at all community sites, 597 men (47%) did so at work sites and 438 (35%) did so at churches. Per site, the largest percentage of men who had never been screened was at work sites (n = 276, 46%) and NAACP sites (n = 22, 33.8%). The highest percentage of men who obtained free screening were at the state fairground (14 of 16), churches (256 of 438), and work sites (336 of 597). The most prostate cancers were detected at the housing projects, where 3 of 38 (7.9%) men who were screened received diagnoses of prostate cancer. To reduce prostate mortality rates in African American men, healthcare providers need to make a concerted effort to increase prostate cancer education and screening in this population. To be effective, recruitment of African American men must move from a provider/health site orientation to a consumer/community orientation. These findings indicate that recruitment strategies are more successful if efforts are based in the community or where a large number of African American men live and/or work. Because a history of screening has been shown to be a predictor for current participation, programs need to target men who have not had previous screening ever or within the last year. In addition, the large percentage of men recruited at work sites who had not been screened previously indicates an opportunity for collaboration with healthcare professionals in employee health programs. Efforts to increase participation in prostate cancer screening will be enhanced significantly by eliciting the active involvement of community leaders.