Literacy, Race, And PSA Level Among Low-income Men Newly Diagnosed With Prostate Cancer

African-American men are more likely to be diagnosed with prostate cancer (CaP), at higher stages and PSA levels and with greater stage-specific mortality rates. A variety of socio-economic, biologic, dietary and genetic factors are postulated to contribute to this.

In the July 2006 issue of Urology, Dr. Wolf and associates from Northwestern University report that older age and literacy, once adjusted for race, contribute to men presenting with higher PSA levels at the time of CaP diagnosis.

A total of 308 men from two VA medical centers, a county hospital and a private hospital participated in the study. Mean age was 66.5 years, 68.5% were African-American, 44% were married and 38% reported an annual income under $20,000. Participants completed data about socio-demographic information, and a validated literacy test was administered. Elevated PSA levels (defined as above 20ng/ml) were found in 23%, and the median PSA level was 7.9ng/ml.

Factors significantly associated with low literacy included PSA level and race, but not marital status, annual income or age. African-American men were 3-times more likely to have lower literacy skills (6th grade or less for 23% of African-American men compared to 7.1% of Caucasian men). Participants diagnosed with a PSA level of 20ng/ml had a 1.4-fold greater rate of low literacy skills. The median PSA level at diagnosis was higher among low literate patients than among men with marginal or functional literacy skills (11.8 vs. 8.2 vs. 6.3, respectively).

Multivariate analysis revealed that low literacy skills and older age predicted for a PSA level >20ng/ml at the time of diagnosis. After adjustment of literary skills and age, African-American race was not a significant independent predictor of a greater PSA level at diagnosis. Literacy contributed to a 35% reduction in the association between race and PSA level. Study limitations include the fact that race and literacy were strongly associated with one another in the sample, making determination of independent affects difficult.

By Christopher P. Evans, M.D.

Urology Volume 68, Issue 1 , July 2006, Pages 89-93
Michael S. Wolf, Sara J. Knight, E. Allison Lyons, Ramуn Durazo-Arvizu, Simon A. Pickard, Adnan Arseven, Ahsan Arozullah, , Kathleen Colella, Paul Ray and Charles L. Bennett
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