Does Education Level Predict PSA Screening and Prostate Cancer Survival?

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Socioeconomic status, including education and income level, appears to be tied to prostate-specific antigen test results and prostate cancer treatment and survival, but the exact nature of these assoc
Socioeconomic status, including education and income level, appears to be tied to prostate-specific antigen test results and prostate cancer treatment and survival, but the exact nature of these assoc

The reasons for the association between socioeconomic status (SES) and prostate cancer outcomes are unclear. Findings from a newly published study in Finland suggest, however, that education level, rather than income-related access to screening and cancer care alone, might help to explain higher prostate cancer–related mortality rates among men in lower SES groups.1

Health care services in Finland are publicly reimbursed, resulting in low levels of SES-related disparities in access to care, the study authors noted. This reimbursement system allowed them an opportunity to evaluate the relationship between education and prostate cancer outcomes.

Their retrospective, registry-based analysis identified 95,076 Finnish men diagnosed with prostate cancer between 1985 and 2014. The authors collected data on tumor stage at diagnosis and year of diagnosis, and matched this information to education level using a separate national database. Patients diagnosed between 1985 and 1994 were treated as the “pre-PSA [prostate-specific antigen]” group and those diagnosed after 1994 were defined as PSA-era cases. Education level was categorized as basic, upper-secondary, and higher education.

For men diagnosed with localized prostate cancer, higher education level was associated with higher prostate cancer–specific survival (PCSS; 68% vs 63% among men with basic education in the pre-PSA, 90% vs 85% since then). Among men with localized prostate cancer, relative risk (RR) for prostate cancer–specific mortality (PCSM) for those with higher education vs those with only basic education was 0.76 (95% CI: 0.66-0.88) in the pre-PSA era and 0.61 (95% CI: 0.53-0.70) after 1994.

The findings corroborate those of other studies that linked SES and education to prostate cancer screening, treatment, and mortality, according to lead study author Heikki Seikkula, MD, of the department of urology at Turku University Hospital in Finland.

“It seems that fewer men with low SES undergo PSA testing and thus prostate biopsies,” Dr Seikkula told Cancer Therapy Advisor. Men with less education are more frequently diagnosed after their prostate cancer has already progressed to advanced stages.

The findings are “worrying” and should be taken seriously, Dr Seikkula said. They suggest that, in Finland, at least, there exists an “urgent need to improve health awareness of citizens with low education level.

“We could avoid unnecessary and preventable cancer-related deaths of these individuals. I would consider it beneficial to either target PSA screening to men with lower education level or to offer population-based PSA screening for all male citizens. The latter option would be easier to accomplish.”

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