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American Journal of Men's Health logoLink to American Journal of Men's Health
. 2025 Jun 23;19(3):15579883251343956. doi: 10.1177/15579883251343956

Understanding Drivers of Prostate Cancer Screening in Mexican-Origin Men Along the U.S./Mexico Border Region

Adriana Maldonado 1,*,✉, Julio C Loya 2,*, Edgar A Villavicencio 1, Rogelio Torres 3, Edward Sanchez 3, Erik Luzanilla 3, Tomas Garcia 3, Luis Vazquez 3, Richard M Hoffman 4, Emma Torres 3, David O Garcia 1
PMCID: PMC12185942  PMID: 40548670

Abstract

The U.S. Preventive Services Task Force recommends individualized decision making about prostate cancer screening for men between 55 and 69 years of age. Compared to non-Hispanic Whites, Hispanic men are less likely to report having had a prostate-specific antigen test. While these differences have been attributed to individual- and system-level barriers in early detection and screening of prostate cancer (PCa), less is known about Mexican-origin men perceptions of barriers to PCa screening. Using a community-based participatory research approach, we conducted semistructured interviews (5 men with PCa history; 15 men without PCa history) to characterize Mexican-origin men’s knowledge, beliefs, attitudes, and experiences with PCa screening in Yuma County, Arizona. Mexican-origin men viewed genetic predisposition as the main driver of PCa, yet participants highly endorsed PCa screening as reflected by the high rates of PCa screening in our study sample. Further, men spoke to how PCa is a taboo subject among Mexican-origin men and how getting screened for it is often perceived as a threat to their manhood. Finally, Mexican-origin men identified a variety of system-level barriers to PCa screening including lack of health insurance, elevated medical costs, and lack of transportation. The study findings add to an emerging body of literature on determinants of PCa screening among Mexican-origin men. The results of this study have significant implications for public health as they underscore the need for multifaceted interventions that target both individual behaviors and broader social influences to increase PCa screening rates among Mexican-origin men.

Keywords: prostate cancer, prostate cancer screening, Mexican-origin adults, rapid qualitative analysis, community-based participatory approach

Background

Prostate cancer (PCa), the most diagnosed cancer in the United States, is the number one malignancy diagnosed among Hispanic men accounting for approximately 22% of all cancer cases (Miller et al., 2021). Estimates indicate that 2,600 Hispanic men die from PCa annually with 5-year survival rates 4% lower compared to non-Hispanic White (NHW) men (American Cancer Society, 2024). While as a group, Hispanic men have a lower incidence of PCa than NHW men (Barry & Simmons, 2017), within-group disparities in PCa presentation exist. For instance, compared to other Hispanic men, Mexican-origin men have worse PCa characteristics at diagnosis, including higher median prostate-specific antigen (PSA) levels and Gleason scores, and more advanced-stage cancers (Del Pino et al., 2022).

The U.S. Preventive Services Task Force (USPSTF, 2018) advises individualized decision making about PSA screening for men between ages 55 and 69; however, adherence to the USPSTF guidelines for PSA screening is low. Compared to NHWs, Hispanics are significantly less likely to report having had a PSA test in the last year (20% vs. 39%; Hosain et al., 2011; Kensler et al., 2021; Manoharan et al., 2025; Ryan et al., 2024). Similar trends have been observed among Mexican-origin men, with estimates indicating that 41.5% of Mexican-origin men had a PSA in the last year, a screening rate well below that observed among other Hispanic men (Sheinfeld Gorin & Heck, 2005). Several barriers prevent men from being screened for PCa, including limited healthcare access (Barlow et al., 2023; Mahal et al., 2017), limited knowledge about PCa (Blocker et al., 2006; Ferrante et al., 2011; Forrester-Anderson, 2005; Lee et al., 2011; Patel et al., 2010; Sanchez et al., 2007; Shelton et al., 1999; Webb et al., 2006), and low personal perception of PCa risk (Hanna et al., 2020). Nevertheless, it is important to note that most of these findings have been drawn from non-Hispanic Black samples, limiting its applicability to Hispanics and more specifically, Mexican-origin men.

Given most studies often report Hispanic populations in aggregate, less is known about Mexican-origin men perceptions of barriers to PCa screening in the United States. However, findings from studies conducted in Mexico provide some insight into factors that might hinder men’s PCa screening behaviors. For instance, it has been found that low perception of PCa risk is associated with lower odds of undergoing a digital rectal exam (DRE), the recommended screening method in Mexico (Balderas-Ortega et al., 2023; Lajous et al., 2019). This is of note, as it has been recently suggested that cultural taboos surrounding DRE is among the most significant barriers to PCa screening in Mexican men (Martin-Dorantes et al., 2025). Additional barriers to PCa screening include, limited knowledge about prostate and prostate health, limited awareness about PSA screening, lack of familiarity with screening guidelines (e.g., recommended age), limited access to healthcare services, lack of trust in the healthcare system, and cost (Hevia, 2006; Martin-Dorantes et al., 2025; Torres-Sánchez et al., 2016; Tristán-Martínez et al., 2022). Given that Mexican-origin men are largely underrepresented in the PCa literature in the United States, the current study applied a qualitative lens to describe knowledge, beliefs, attitudes, and experiences of Mexican-origin men on PCa screening in Yuma County, Arizona.

Methods

Community–Academic Partnership

Guided by a community-based participatory research (CBPR) approach, Campesinos Sin Fronteras (CSF) served as the trusted entity for the implementation of this research. With more than 30 years serving farmworkers and low-income individuals in Yuma County, CSF has extensive experience facilitating access to healthcare and social services to local individuals. CSF longstanding presence in the community was instrumental in recognizing the lack of PCa awareness and screening uptake as a key area of interest among Mexican-origin men in Yuma County. Building on the trust and community immersion from CSF, the academic research team guided further steps in the development and application of qualitative methods with the purpose of designing targeted interventions to address and improve PCa screening rates among this population. This approach was determined to be appropriate as members of the academic research team have deeply connected roots to Mexican-origin communities and committed to improving their health outcomes. Through this community-engaged participatory research framework, CSF identified PCa as a critical issue, highlighting the need for interventions to increase awareness and early detection. By acknowledging power dynamics and prioritizing ethical practices of research implementation, both CSF and the academic team prioritized a strong partnership toward developing sustainable health improvements in the community of interest.

Study Design, Sampling, and Recruitment

Semi-structured interviews were used to understand adults’ beliefs, attitudes, and experiences of Mexican-origin men on PCa screening in the Southern Arizona border region. A convenience sample of 20 Spanish-speaking Mexican men (15 with no history of PCa and 5 with a history of PCa) was recruited into the study. To determine our sample size, we followed recommendations that suggest sampling between 20 and 35 participants to reach theoretical saturation in qualitative studies (Creswell, 1998; Mason, 2010; Teddlie & Yu, 2007). Eligible participants (1) were ≥40 years of age, (2) self-identified as Mexican-origin, (3) either worked or resided in Yuma County, and (4) were able to provide informed consent. A combination of strategies that are known to be effective when recruiting hard-to-reach populations was used to identify and enroll study participants: face-to-face interactions, social media, flyers, radio, and word of mouth (Domenech-Rodríguez et al., 2006; Ojeda et al., 2011; Thornton et al., 2016). All materials were developed in consultation with CSF to ensure appropriateness toward the population of interest. The University of Arizona (IRB) approved all protocols for this project (IRB Protocol Number: STUDY00003973). All participants provided informed consent prior to any data collection or recruitment efforts taking place.

Data Collection

CSF male community health workers (CHWs) were trained in qualitative research methods by the lead author (A.M.). CHWs attended a 2-hr training course that covered a general description of qualitative research, the qualitative research process, and rigor in qualitative research. Data collection occurred between April and July 2024. Informed by the health-belief model (Janz & Becker, 1984), a semi-structured interview guide was developed to gather information about Mexican-origin men’s knowledge of PCa, perceptions on susceptibility and severity of PCa, perceived barriers and benefits to PSA testing, and cues to action (see Table 1 for example interview questions). Semi-structured interviews were conducted in-person in Spanish by CSFs’ male CHWs to facilitate rapport between study participants and research team. To monitor data collection, the first five interviews were audited for quality by the lead author. After an interview lasting only 10 min, a 1-hr booster training on best practices for data collection (e.g., use of probing questions) was conducted. Interviews lasted 29 min on average (range 10–64 min). Data collection occurred until theoretical saturation was achieved (Creswell, 1998; Mason, 2010; Teddlie & Yu, 2007). All interviews were digitally audio-recorded and transcribed verbatim by a professional transcription service. Upon completion of the interview, participants completed a brief demographic questionnaire and self-reported medical history that facilitated characterization of the study sample. Participants received a $25 cash incentive to compensate them for their time.

Table 1.

Interview Sample Questions

1. What do you think about when you hear prostate cancer?
¿Que se le viene a la mente cuando escucha el termino cáncer de próstata?
2. Do you know of any type of exam that detects prostate cancer?
¿Usted sabe de algún tipo de examen que detecte el cáncer de próstata?
3. What benefits do you think Hispanic men can obtain when they complete prostate cancer screening tests?
¿Qué beneficios cree que puede obtener los hombres hispanos al realizar pruebas de detección de cáncer de próstata?
4. What would you say are some of the reasons Hispanic men do not complete prostate cancer testing?
¿Cuáles podrían ser algunas de las razones por las que los hombres hispanos no se hacen pruebas de detección del cáncer de próstata?
5. In your opinion, what do you think would increase Hispanic men’s participation in prostate cancer screenings?
En su opinión, ¿qué cree que aumentaría la participación de los hombres hispanos en los exámenes de detección de cáncer de próstata?
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Data Analysis

A rapid qualitative analysis, a form of directed content analysis, was conducted to identify themes and their corresponding participant quotes (Taylor et al., 2018; Watkins, 2017). Prior to data analysis, authors A.M. and J.L. engaged in active reading of each transcript to identify preliminary patterns of meaning and develop a codebook (MacQueen et al., 1998). To polish the analytical process, identify problematic codes, and refine code definitions, authors A.M. and J.L. coded a random number of interview transcripts (n = 6, 25%). This proportion was chosen based on previous recommendations suggesting that 15% to 25% of transcripts should be coded by a second coder (Lilgendahl & McAdams, 2011; McLean & Pratt, 2006; O’Connor & Joffe, 2020; Syed & Nelson, 2015). Discrepancies in coding were discussed, and revisions were made to the codebook based on the initial analysis and discussions. Once a final codebook was developed, A.M. and J.L. read interview transcripts and assigned codes to transcript excerpts. All final codes were sorted into themes which were provided with a definition and descriptive labels to ensure analytical rigor during the review process. To assist in the development of themes and to facilitate comparisons between participants without PCa history and those with PCa history, descriptive MS Excel matrix displays were created to identify code overlap and relationships among codes (Miles & Huberman, 1994). The research team engaged in a series of iterative discussions with CSFs’ CHWs to identify information that might have been overlooked and to confirm the interpretation of the themes. To ensure the fidelity of the information provided by participants regarding their experiences with PCa knowledge and experience, transcripts were analyzed in their original language and only quotes shown in this manuscript were translated to English for dissemination purposes. Furthermore, to maintain participants’ anonymity, any potentially identifying details were redacted and all respondents were assigned pseudonyms.

Results

Participant Characteristics

Table 2 presents participants’ characteristics by history of PCa. Participants mean age was 64 years; however, those with no history of PCa tended to be younger compared to those with a history of PCa (M = 61.4 years vs. 70.8 years, respectively). Most participants indicated being married across both groups (71.4% no PCa history vs. 80% PCa history). While majority of participants indicated renting a house, the proportion was slightly higher among men with PCa history compared to their counterparts (60% vs. 53.3%). Across groups, most participants did not graduate high school (60% no PCa history vs. 60% PCa history). Men without PCa history were more likely to be employed compared to those with PCa history (53.3% vs. 20%). On average, participants have been in the United States for 36 years (SD = 13); however, the mean years of time in the United States were slightly higher for those with a PCa history than those without a history of PCa (36.5 years vs. 35.3 years, respectively). Access to health insurance was high in both groups; however, all participants with a PCa history indicated having health insurance compared to only 80% among those without PCa history. In addition, participants with a PCa history were more likely to seek medical care in Mexico compared to their counterparts (100% vs. 46.7%). In fact, most participants reported having access to a primary care provider (73.3% no PCa history vs. 100% PCa history). Of the total sample, most participants reported having had a PSA test (80%) or a DRE (60%). Other cancer and chronic disease screenings are reported in Table 2.

Table 2.

Participant Characteristics

Sample Characteristics No PCa history (n = 15) History of PCa (n = 5)
Demographics
 Age (M = 64 years, SD = 8.27)
  Less than 50 years 6.7% (n = 1) —
  50–59 years 33.3% (n = 5) —
  60–69 years 46.7% (n = 7) 60% (n = 3)
  70–79 years 13.3% (n = 2) 20% (n = 1)
  80 years and older — 20% (n = 1)
 Marital status
  Never married 7.1% (n = 1) —
  Married or cohabitating 71.4% (n = 10) 80% (n = 4)
  Divorced, separated, widowed 21.4% (n = 3) 20% (n = 1)
 Housing status
  Rent 53.3% (n = 8) 60% (n = 3)
  Own 46.6% (n = 7) 40% (n = 2)
 Educational attainment
  Did not graduate high school 60% (n = 9) 60% (n = 3)
  Graduated high school 20% (n = 3) 20% (n = 1)
  Attended college 13.3% (n = 2) —
  Graduated from college 6.7% (n = 1) 20% (n = 1)
Employment status
  Employed 53.3% (n = 8) 20% (n = 1)
  Unemployed 13.3% (n = 2) —
  Out of labor force 1 33.3% (n = 5) 80% (n = 4)
 Annual household income
  Less than $20,000 33.3% (n = 5) 60% (n=3)
  $20,001 to $35,000 33.3% (n = 5) 20% (n = 1)
  More than $35,001 33.3% (n = 5) 20% (n = 1)
 Time in the United States (M = 36 years, SD = 13)
 Less than 10 years 6.7% (n = 1) —
 10–29 years 13.3% (n = 2) 20% (n = 1)
 More than 30 years 73.3% (n = 11) 60% (n = 3)
Health-related factors
 Health insurance
  Yes 80% (n = 12) 100% (n = 5)
  No 20% (n = 3) —
 Insurance type
  Employer-based insurance plan 23.1% (n = 3) —
  Individual health insurance plan 7.7% (n = 1) —
  Medicare, Medicaid, state program 15.4% (n = 2) 40% (n = 2)
  TRICARE, VA, military insurance plan — 20% (n = 1)
  Other source 46.1% (n = 6) 40% (n = 2)
 Seek medical care in Mexico
  Yes 46.7% (n = 7) 100% (n = 5)
  No 53.3% (n = 8) —
 Access to primary care provider
  Yes 73.3% (n = 11) 100% (n = 5)
  No 26.7% (n = 4) —
Health screening behaviors
 Prostate-specific antigen test
  Yes 73.3% (n = 11) 100% (n = 5)
  No 13.3% (n = 2) —
 Digital rectal exam
  Yes 53.3% (n = 8) 80% (n = 4)
  No 33.3% (n = 5) 20% (n = 1)
 Other cancer screenings*
  Colon cancer 46.7% (n = 7) 40% (n = 2)
  Liver cancer 20% (n = 3) 20% (n = 1)
  Skin cancer 13.3% (n = 2) 20% (n = 1)
  Lung cancer 20% (n = 3) 20% (n = 1)
  Testicular cancer 26.7% (n = 4) 20% (n = 1)
  Kidney cancer 13.3% (n = 2) 20% (n = 1)
  Oral cavity cancer 20% (n = 3) 20% (n = 1)
 Chronic disease screenings*
  Hypertension 86.7% (n = 13) 20% (n = 1)
  Type 1 diabetes 46.7% (n = 7) 40% (n = 2)
  Type 2 diabetes 53.3% (n = 8) 60% (n = 3)
  Cholesterol 66.7% (n = 10) —
  Liver disease 13.3% (n = 2) 20% (n = 1)
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Note. 1Out of labor force includes retired individuals and those who were unable to work at the time of data collection.

*

Multiple response options were allowed.

Knowledge of PCa and Related Risk Factors

Participants described PCa as a hereditary disease. Specifically, participants mentioned that if there is family history of PCa, men need to be closely monitored by healthcare providers. As Jesus (age 56, no PCa history) mentioned:

“…It depends on the family genetics. If the parents have suffered from it, the descendants should have more medical observation.”

Several participants also mentioned that men’s risk for developing PCa is closely tied to their lifestyle behaviors, including diet, drug use, sexual practices, and tobacco use. For example, Alonso (age 57, no PCa history) described how diet is a main risk factor for PCa:

“First of all, I think it's the diet, because nowadays we eat many things. Now, many foods already contain a lot of chemicals.”

Participants with PCa also mentioned how facing treatment decisions led to increasing their PCa knowledge. For example, Cesar (age 65, PCa history) stated:

“I searched and read a lot about different techniques, and saw the results of different procedures… I also saw all about side effects… I opted for that (radiation), because according to everything I've read, the results are basically the same (as surgery).”

Knowledge of PCa Screening Methods and Attitudes Toward PCa Screening

Overwhelmingly, participants mentioned that both the PSA test and DRE were the two most used screening methods. As noted by Jesus (age 56, no PCa history):

“The blood test [PSA] and the digital rectal exam [DRE] that the doctor performs by pressing the prostate with their finger. And they will feel if there is an inflamed prostate or a prostate that is beginning to become inflamed. And that's when the treatment begins.”

Several participants further elaborated on the accuracy of the tests to detect PCa. Ricardo (age 49, no PCa history), explained: “They explained to us in school that the older or most accurate method has been the digital exam, they [inaudible] through the rectum, and then there’s the blood test [PSA], but they say it’s not very accurate.” Jesus (age 56, no PCa history) further described:

“They did both tests on me and we're fine… I remember they sent it to the laboratory, but I learned that the best response is from the rectal exam with the doctor's finger, because they will instantly know if it's inflamed or if there's no problem. And the other one is a laboratory test, a blood test. I decided to have both done to be sure and continue my healthy life.”

Participants also mentioned that the biggest benefit of screening is early detection and control of PCa. For example, Mario (age 70, no PCa history) elaborated on how screening can help detect PCa early and prevent it from advancing to more severe stages:

“I mean that if we're checking ourselves frequently, as doctors say, then we can find that the cancer they're going to diagnose is caught in time. Yes, in the first stage of prostate cancer, when it hasn't yet spread to other organs. So, it may be possible to cure that… When the cancer has already spread, it's impossible to stop it. But if caught in time, it can be cured, because there are already many people who have had their prostate removed and survive cancer from the beginning.”

While most participants indicated having been screened for PCa, most participants mentioned that feeling embarrassed prevented some individuals from getting screened. As expressed by Rafael (age 69, no PCa history), “Hispanics don’t like having this done to them… it’s not fear, it’s shame that people have, about having a finger inserted.” However, several participants also acknowledged that while getting screened could be uncomfortable, particularly if a DRE is requested by their medical provider, the benefits of the procedure outweigh the awkwardness of the experience. As noted by Fernando (age 64, no PCa history):

“I did feel embarrassed, of course I did. Of course you feel it, but for me it was more important—my motivation was higher than the embarrassment, because I know that if cancer is detected in me now, I can have a better chance of surviving it.”

While participants mentioned discussing PCa screening results with their healthcare provider, a majority of participants described sharing their test results with their family. Benjamin (age 62, no PCa history) explained the importance of keeping open communication within the family in regard to discussing health issues: “In the family because there’s nothing to hide, you have it, you already have it… You have to discuss it with the family.”

Few participants also disclosed their desire to share their PCa screening results with their spouse as they are their primary confidant and support person. Rafael (age 69, no PCa history) noted, “With my wife… Because she’s my wife and we’re the ones who are looking out for each other, just about what’s happening to you and what’s happening to me. Because who else would be interested in this? No one else. Who else? It's not like a friend would be interested in what might happen to me.”

Barriers to PCa Screening

Several barriers to PCa screening were identified by participants including machismo, lack of transportation and competing job demands, lack of health insurance and elevated medical costs, and fear of receiving a positive PCa diagnosis.

Cultural Barriers

Participants identified machismo as a major barrier to PCa screening. Participants described that in the Mexican culture, getting screened for PCa is often seen as threat to their manhood, and thus, it is preferable to die from cancer than getting screened. As described by Jonathan (age 62, no PCa history):

“The older men used to say they preferred to die from that… and I had some neighbors, about two of them died from prostate [cancer], but they never went to get checked. When one of them finally went to get checked, well, it was already too late… Because, you see, they would do the rectal exam, it was more old-fashioned before, I mean, there wasn't—science wasn't so advanced. And they preferred to die like that instead.”

Similarly, Mario (age 70, no PCa history) mentioned “One barrier would be machismo. ‘You’re not going to touch me there’. I’ve heard of people who will not allow themselves to be touched for a cancer and prostate exam, they prefer to stay as they are, rather than know what’s happening in there.”

Fear of Receiving a Positive PCa Diagnosis

Due to participants’ perception of PCa being an “incurable disease,” participants described how men feared undergoing PCa screening and getting a positive diagnosis. As Santiago (age 63, no PCa history) mentioned: “Fear, that one might—many people don’t go and get exams done because of the fear that they might have cancer… That they might detect cancer. So, they prefer to stay as they are, and let whatever God wants happen.” Similarly, Sebastian (age 55, no PCa history) described what he had observed among his colleagues with inflammation in the prostate:

“I've heard about coworkers who have had prostate inflammation and have gone to get tests done, but they also go with tremendous fear, when they have suffered this type of prostate inflammation. And when they're going to get the studies done is when you can see the fear they have.”

Lack of Health Insurance and Elevated Medical Costs

Participants also described how lack of health insurance coupled with elevated medical costs were two major deterrents for men to get screened. Alonso (age 57, no PCa history) explained:

“Many times, there are people who also [say], “Well, how much is the exam going to cost me?” And many people don’t—like right now with this situation where there’s no work, everything has calmed down, the last thing one wants to do is spend… So, one has to say: ‘“No, well I barely have enough to eat or drink this. And how could I have an exam that’s going to cost me 1,000 pesos [equivalent to $49.00 USD]?”’ Many people also stop there. ‘“I don’t have it right now.”’

Similarly, Daniel (age 58, no PCa history) expressed how lack of health insurance can be a significant barrier for PCa screening:

“If you don't have insurance or you don't have Medicaid or something like that to give you help, you're not going to go get checked. If you don't have it, if you don't have some kind of—because many people here live day to day, they live like that, they're not going to go, because that's expensive. So, they're not going to—it's because of the economic situation that if you don't have money, you're not going to go get checked.”

Similarly, Cesar (age 65, PCa history) mentioned: “Well, the cost of medical exams and medical treatment is expensive, I won’t deny it…Many friends don’t have insurance, and it’s difficult [to obtain treatment] ….”

Lack of Transportation and Competing Job Demands

A few participants further elaborated on how lack of reliable transportation hinders men’s motivation to get screened for PCa. As Daniel (age 58, no PCa history) explained: “…There are many who cannot drive, who if you don’t take them, they won’t go many times.” However, participants acknowledge that they could rely on their network to overcome transportation barriers. As Alejandro (age 68, no PCa history) expressed: “…If you don’t have a car, there are plenty of people who have a car and can give you a ride… It’s just a matter of whether you want to [schedule an appointment].”

Competing job demands and lack of flexibility in their jobs were also mentioned by participants as barriers to PCa screening. For instance, Alonso (age 57, no PCa history) described:

“Sometimes it's not very easy [to schedule a screening appointment], because many times you find yourself busy, working, doing things that sometimes don't leave you time… Many times, that's why one stops, because: “No, well, I have the appointment for such and such a day, but I have things to do and well, I'm going to postpone it.”

Alonso further mentioned, “Many times that [postponing appointments] is what we do, because of work because you can’t leave work, it becomes difficult to let people down, the mayordomo, the company, or that they don’t give you permission.”

Discussion

Using a qualitative approach, this study sought to describe knowledge, beliefs, attitudes, and experiences of Mexican-origin men on PCa screening in the Southern Arizona border region. While most participants indicated having had a PSA or a DRE to screen for PCa, participants described how unique cultural, social, and healthcare-related factors interact to influence Mexican-origin men’s decision to undergo PCa screening. The study findings offer a comprehensive understanding of the challenges and opportunities for improving PCa screening among Mexican-origin men in the Southern Arizona border region.

Similar to previous work, Mexican-origin men viewed genetic predisposition as the main driver of PCa, yet participants highly endorsed PCa screening (McFall et al., 2006; Vapiwala et al., 2021). This is surprising as it has been previously suggested that perceptions that cancer is caused solely by genes—genetic fatalism—act as a barrier to PSA screening (Walter et al., 2004). However, the fact that 80% of our sample had been screened for PCa suggests that engaging in PCa screening behaviors might be perceived by men as a way to regain control of their health. Nevertheless, it is important to note that men expressed confusion over the accuracy of PCa screening methods, did not know that DRE is no longer a recommended screening test, and were unaware of potential risks and harms associated with PCa screening and/or treatment. This is worth mentioning as it has been previously documented that among ethnic/racial minority groups, there is a degree of mistrust on the precision of PSA tests and DRE in detecting PCa (Vapiwala et al., 2021). Thus, PCa interventions, particularly those focused on promoting PSA screening, might benefit from incorporating tenets of informed decision making (Carrion et al., 2022; Sheetz et al., 2024).

Consistent with previous research, cultural and social factors played a significant role in shaping Mexican-origin men’s attitudes toward PCa screening (Ferrante et al., 2011; Larkin et al., 2022; Vapiwala et al., 2021). Overwhelmingly, men spoke to how PCa is a taboo subject among Mexican-origin men and how getting screened for it is often perceived as a threat to their manhood. Given that for many Hispanic men, their genitalia represent a reference point of their masculinity, these results are not unexpected (Rivera-Ramos & Buki, 2011). This idea is confirmed by men’s mentioning how their perceptions of manhood influenced PCa screening intentions. For example, few participants mentioned statements like “we don’t like to get that done [DRE], it’s not being afraid, it is the shame of having someone inserting a finger in you.” In addition, men often cited machismo as one of the factors shaping attitudes toward PCa screening, which reflects a broader societal trend in Hispanic cultures where men may feel pressure to uphold a strong, stoic image. This is of note, as it has been suggested that this sense of masculinity may discourage men from seeking preventive health behaviors (Castaldelli-Maia et al., 2024). Thus, efforts are needed to de-stigmatize PCa screening, diagnosis, and treatment to address well documented disparities in disease presentation among Hispanic men.

In fact, previous research in other populations such as African immigrant men found some similar results regarding PCa screening barriers, including cultural barriers and fear of receiving a positive PCa diagnosis. Specifically, our study found that some men may perceive PCa screening as a threat to their manhood. Likewise, evidence suggests that African immigrants may equate prostate health challenges with a perceived challenge to manhood (Malika et al., 2020). Additionally, our study found that some participants expressed fear as a barrier to PCa screening. Some participants mentioned the fear of receiving a positive cancer diagnosis and not knowing about a cancer diagnosis was preferable than experiencing the fear involved in the screening process itself. This is similar to previous results in a study comparing African American, and NHW participants suggest that a higher proportion of African American participants would prefer to not know if they have a PCa diagnosis (Hewitt et al., 2018). Our findings demonstrate the need to inform the development of interventions to increase PCa screening based on the understanding that there are cultural differences present in Mexican men.

In line with previous work, Mexican-origin men identified a variety of system-level barriers to PCa screening including lack of health insurance, elevated medical costs, and lack of transportation (Oduro et al., 2013; Ogedegbe et al., 2005). While most of our study sample indicated having health insurance, close to 50% of men were unemployed at the time of data collection. This is of note, as the U.S. healthcare system is supported by employer-based health insurance, which excludes individuals who are unemployed, work part-time, or are in seasonal positions, preventing them from accessing screening services (Siddiqi et al., 2009). Thus, efforts to subsidize PCa screening costs are warranted. Lack of reliable transportation to screening sites was also identified as a barrier to PCa screening. Men often reported relying on co-workers or family members that may or may not be available to drive them to PCa screening appointments. This is further exacerbated by the fact that Yuma County is a medically underserved area, which requires long travel distances to access healthcare services (Arizona Department of Health Services, 2024). This is of note, as disparities in overall PCa mortality have previously been linked to long travel distances for treatment (Vetterlein et al., 2017). Together, these findings highlight the need to consider the local context when developing and implementing PCa screening interventions.

Strengths and Limitations

Despite the study’s contributions, several limitations warrant discussion. The study sample was recruited from a specific geographic area and may not fully represent the heterogeneity of Mexican-origin men across different regions, socioeconomic status, or generational status. Nonetheless, this is among the first studies to document Mexican-origin men’s knowledge, beliefs, attitudes, and experiences of Mexican-origin men on PCa screening in the Southern Arizona border region. Thus, future research should include a broader, more diverse sample to capture a wider range of experiences and perspectives. Further, while face-to-face interviews allowed for in-depth exploration of individuals’ experiences, in some cases, it could have led to bias for social desirability. However, because CSF CHWs heavily relied on the Hispanic cultural principles of respeto (respect) and charla (small talk), conducted all of the interviews in Spanish, and actively reiterated to participants that they were not being evaluated, we found that most participants were eager to share their experiences with PCa screening (Bergen & Labonté, 2020; Gallardo, 2013).

Public Health Implications

While beyond the scope of the current study, several strategies emerged from the interviews that could help promote PCa screening among Mexican-origin men. One key strategy emphasized by participants was the need for community outreach efforts that are culturally tailored, along with education efforts. This is of significance, as culturally tailored educational interventions have been shown to increase PCa screening using PSA testing (Adams et al., 2020; Ukoli et al., 2013). Thus, educational materials in Spanish, such as patient decision aids, as well as outreach efforts in Hispanic communities, could help bridge the knowledge gap and empower men to make informed decisions about PCa screening. In addition to providing information, participants suggested that testimonials from PCa survivors could play a pivotal role in encouraging screening by dispelling some of the myths surrounding PCa. Hence, providing workshops that incorporate cultural preferences and customs could be an effective manner to increase PCa literacy among Hispanic men address misconceptions, reduce stigma, and create a supportive environment for discussing PCa openly.

Conclusion

In conclusion, findings from this CBPR study add to an emerging body of literature on determinants of PCa screening among Mexican-origin men. The results of this study have significant implications for public health as they underscore the need for multifaceted interventions that target both individual behaviors and broader social influences to increase PCa screening rates among Mexican-origin men. Specifically, they shed light on the need for PCa screening intervention to dispel myths about screening, addressing cultural stigmas surrounding PCa, and providing practical solutions to overcome barriers like healthcare access and affordability. However, continued research is needed to better understand the influence of the interplay of PCa knowledge, screening attitudes, access barriers, and cultural influences on Mexican-origin men’s intentions to get screened for PCa.

Acknowledgments

We acknowledge all study participants, Campesinos sin Fronteras staff, the Nosotros staff, the University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment, and the University of Arizona Cancer Center.

Footnotes

Ethical Considerations: The University of Arizona Institutional Review Board (IRB # STUDY00003973) approved all study materials and research protocol.

Author Contributions: Conceptualization: A.M., D.O.G., E.T., R.T. Methodology: A.M., J.C.L., E.A.V., R.M.H. Formal analysis and investigation: A.M., J.C.L., R.T., E.S., E.L., T.G., L.V. Writing—review and editing: A.M., J.C.L., E.A.V., R.T., E.S., E.L., T.G., L.V., R.M.H., E.T., D.O.G.

Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of Arizona Cancer Center Community and Academic Partnership Program (CAPP) grant awarded to D.O.G. and E.T.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to the sensitive nature of the information collected as part of the study.

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