Knowledge, willingness, and reported prior prostate cancer testing among men in Palestine: a cross-sectional online survey.

Background: Evidence on prostate cancer (PCa) knowledge and PSA-related testing behavior in Palestine remains limited. We assessed general awareness, factual knowledge, willingness to undergo PSA testing if offered, reported prior PSA testing/prostate examination, and factors associated with prior testing. Methods: We conducted a cross-sectional online survey from 19 November to 21 December 2025 among adult men aged 18 years or older recruited from Palestinian communities. The full cohort comprised 1,047 consenting participants. The exported dataset contained two incompatible response formats for the 12 factual knowledge items; composite knowledge analyses were therefore limited to 568 respondents with complete, unambiguous single Yes/No responses. Knowledge was scored from 0 to 12 using the study answer key. Willingness and prior testing were analyzed as binary outcomes. Multivariable logistic regression assessed factors associated with prior testing. Results: Mean age was 28.7 ± 12.4 years and 78.6% were aged 18-39 years. Overall, 80.0% had heard of PCa, 26.1% had heard of PSA testing, 31.2% were willing to undergo PSA testing if offered, and 5.6% reported prior PSA testing and/or prostate examination. Among the 568 scorable knowledge respondents, mean knowledge was 7.07 ± 1.84 of 12 and 89.1% had limited knowledge (<80% correct); KR-20 was 0.235. Adequate knowledge was associated with lower willingness (12.9% vs 32.8%; p=0.002) but not prior testing (3.2% vs 6.1%; p=0.526). In the full cohort, older age (aOR 1.08 per year; 95% CI 1.05-1.10), healthcare background (aOR 2.10; 95% CI 1.17-3.77), and first-degree family history (aOR 2.22; 95% CI 1.01-4.86) were independently associated with prior testing. Among never-tested participants, the leading reported barriers were low perceived personal risk (55.3%) and lack of physician/healthcare-provider recommendation (43.1%); multiple responses were allowed. Conclusions: In this predominantly young online sample, general awareness exceeded detailed factual knowledge, while willingness and reported prior testing were low. The divergence between knowledge and behavior should be interpreted cautiously because knowledge analyses used a restricted subset and the shortened scale had low internal consistency. Findings support culturally appropriate, risk-adapted clinician-patient communication and further validation of locally adapted measurement tools.