Linda Svensson: Personal factors shape the decision to test for prostate cancer

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LINDA SVENSSON
Dissertation defense: 5 December 2025 (click for details)
Doctoral thesis: Prostate cancer screening – Attendance and psychological consequences
Research area: Urology
Sahlgrenska Academy, The Institute of Clinical Sciences

Prostate cancer is the most common cancer among men in Sweden. Because the disease often develops slowly, general screening has long been debated. Since 2020, men have instead been offered organized prostate cancer testing, where they receive neutral information about the pros and cons and decide for themselves whether to be tested.

Men generally positive towards testing

Men in Linda Svensson’s studies were generally positive towards organized prostate cancer testing, and most found the information about the advantages and disadvantages of testing clear. However, many had difficulty assessing more complex concepts such as overdiagnosis and false-positive results.

“The decision to test their PSA or to refrain was not mainly influenced by the information in the letter, but by personal factors such as fear of missing a cancer diagnosis, anxiety about the physical examination and loss of masculinity, social support, previous experiences with healthcare, and gut feeling,” says Linda Svensson, specialist nurse in oncology at the Department of Urology, Sahlgrenska University Hospital, and doctoral student at the Institute of Clinical Sciences.

Low anxiety but need for targeted support

The screening process was generally perceived as manageable, and most participants reported only mild psychological reactions.

“Only a small proportion reported moderate to severe anxiety. The results support that organized testing is well accepted, but they also show that some men need additional support during the diagnostic process,” says Linda Svensson.

Men who took part in the first screening round, where the clinical evaluation showed no signs of prostate cancer, were invited to participate again. Participation was generally high, slightly higher among men with PSA levels above the threshold, and about the same regardless of how extensive the biopsy had been during the initial screening.

Clearer guidance needed

Many participants requested clearer support from healthcare authorities during the decision-making process.

“There is strong confidence that early detection is good, but also uncertainty about the risks of overdiagnosis. The information therefore needs to be made even clearer and more guiding.”

What has been the most enjoyable part of the doctoral project?
“The best part has been combining research with my clinical meetings with men in the Gothenburg-2 study. It has deepened my understanding of how they think and react. And I’ve had the privilege of being part of an outstanding research group.”

And the challenges?
“There have been many, but now that I’ve reached this point, they’ve faded. The most difficult part was at the beginning of my doctoral studies – finding my new role after being so firmly established in clinical inpatient care.”

Text: Jakob Lundberg