Low follow-up rate after positive prostate cancer screening in southern China: a community-based cross-sectional survey with a prospective component

Objective Prostate cancer screening enables early detection of asymptomatic cases, but its public health impact depends on timely diagnostic evaluation after a positive result. However, follow-up rates after abnormal screening in community settings remain poorly characterized, particularly in underserved regions of China. This study aimed to investigate the follow-up rate and identify its determinants among men with positive prostate cancer screening results in a community-based cohort in Nanning, Guangxi, to inform targeted interventions. Design Community-based cross-sectional survey with a 3-month prospective component. Methods A cross-sectional study was conducted in a community in Nanning, Guangxi Zhuang Autonomous Region, from June to August 2021. Male residents aged ≥50 years (or ≥45 years with a family history of prostate cancer) who screened positive for prostate cancer (PSA > 4 μg/L) for the first time were eligible. Sociodemographic characteristics, clinical data, and psychosocial factors were collected through community health records and telephone interviews conducted 3 months after result notification. Follow-up was defined as attendance at a hospital for further evaluation within 3 months of receiving the screening result. Multivariate logistic regression was performed to identify factors associated with follow-up attendance. Results A total of 2,939 participants underwent screening, of whom 278 (9.46%) tested positive. After excluding three cases with incomplete data, 275 men were included. Among them, 185 (67.3%) had PSA levels between 4–10 μg/L, and 90 (32.7%) had PSA > 10 μg/L. Only 81 participants (29.45%) attended a follow-up visit within 3 months. Multivariate logistic regression revealed that family awareness of the screening result (OR = 4.87, 95%CI: 1.81–13.10), presence of moderate-to-severe lower urinary tract symptoms (OR = 4.11, 95% CI: 2.14–7.89), and higher prostate cancer knowledge level (OR = 3.36, 95% CI: 1.78–6.36) were independently associated with increased odds of follow-up attendance (all p < 0.05). Conclusion The follow-up rate among men with positive prostate cancer screening results in this community-based Chinese cohort was alarmingly low (29.45%). Family awareness, lower urinary tract symptom severity, and disease-specific knowledge were identified as independent determinants of follow-up behavior. These findings highlight critical gaps in the screening-to-diagnosis continuum and underscore the need for targeted interventions—particularly those enhancing family involvement, improving symptom recognition, and increasing disease knowledge—to improve follow-up rates and ultimately optimize prostate cancer outcomes in community-based screening programs.