Men’s Knowledge, Beliefs, and Behaviors on Prostate Cancer Screening in Sfax: A Cross-Sectional Study

Background and aims: Prostate cancer (PCa) is the second most common malignancy among Tunisian men, although screening uptake remains low due to limited awareness and cultural barriers. Thus, this study aimed to assess the levels of knowledge, attitudes, cultural beliefs, views, and screening behaviors related to PCa among men aged 40 and above in the Sfax region of Tunisia and to identify factors influencing these dimensions. Methods: A descriptive and analytical cross-sectional study was conducted in 2025 among 1,520 men using a structured questionnaire covering sociodemographic and clinical factors, knowledge of PCa, attitudes, cultural beliefs, views, and screening practices. The obtained data were entered, verified, and analyzed using SPSS 25. Ultimately, univariate tests and multivariate logistic regression were used for statistical analysis. Results: Based on the results, participants demonstrated low knowledge (n=922; 60.7%), negative attitudes (n=1304, 85.8%), and moderate cultural beliefs (n=869, 57.2%). Only 7.4% had ever undergone PCa screening (n=113), and 68.7% expressed a willingness to perform screening in the future (n=966). Moreover, screening uptake was significantly associated with high knowledge (OR=4.399, P<0.001), positive attitudes (OR=4.579, P<0.001), and weak cultural beliefs (OR=0.251, P<0.001). Finally, barriers included lack of symptoms (55.2%), financial constraints (47.3%), and low perceived risk (46.3%). Conclusion: Overall, PCa screening remains low in the Sfax region, driven by limited knowledge, negative attitudes, and influential cultural beliefs. In general, higher knowledge and positive attitudes increased screening uptake, while strong cultural beliefs reduced it. Accordingly, improving awareness and addressing cultural and financial barriers are essential to enhance early detection.