Programmes aimed at monitoring men with slow growing prostate cancer may suffer from patient reluctance to co-operate, Swiss researchers have warned.
Many doctors believe that men with slow-growing cancer may benefit from limited treatment as the disease may never pose a serious threat to their lives.
Last week a British study raised doubts about the ability of doctors and pathologists to identify these patients.
Now the latest study, from Baden, Switzerland, reports that about 25% of men dropped out of a monitoring programme for this kind of cancer.
The doctors reported on the fate of some 157 men monitored over a period of 13 years.
During the period some 28% of men were found to need treatment and were "cured".
But some 27% of men failed to show up for appointments and failed to reply to letters.
The findings were reported to the conference of the European Association of Urology in Stockholm, Sweden.
Researcher Dr Lukas Hefermehl said: "We don’t know exactly what the reasons are. It may be that once the patient was told that this cancer is probably not immediately threatening, he might downplay the importance of another test.
"On the other hand some men might have real concerns about the risk of there being a more severe cancer. Or it may be to do with the risk of incontinence or impotence after treatment, the idea of having cancer, a sense that nothing will really happen to them or it may be due to another reason which we just don’t know about."
He added: "The fact is that overall these findings leave us with a practical and ethical dilemma; we often recommend that men go onto an active surveillance programme, but these results indicate that more than a quarter of men will disappear from the system."
Professor Manfred Wirth, of the Technical University of Dresden and treasurer of the association, said the findings were "potentially controversial."
He said: "It is based on clinical practice in the real world. It shows that we may need a clearer understanding of the psychological factors which might get in the way of effective follow up in these points."
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