High PSA Anxiety, Low Health Literacy Associated with Salvage ADT Choice

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Prostate cancer patients with high PSA anxiety, low health literacy who experience recurrence twice as likely to undergo salvage ADT.
Prostate cancer patients with high PSA anxiety, low health literacy who experience recurrence twice as likely to undergo salvage ADT.

Men with prostate cancer who experience PSA recurrence after radiotherapy are twice as likely to undergo salvage androgen deprivation therapy (ADT) if they have high PSA anxiety or low health literacy compared to those who don't.

The findings, published in Annals of Oncology, suggest that many of these men receive higher rates of unproven treatment.

Brandon Mahal, MD, of Harvard Medical School and fellow researchers conducted a prospective study of 375 men from the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma Registry (COMPARE).

In total, 68 who received salvage ADT as initial management for PSA recurrence. The researchers used multivariable logistic regression to determine whether PSA anxiety and health literacy was associated with choice of salvage ADT as initial management.

They found that men with high PSA anxiety were twice as likely to receive salvage ADT compared to those did not have high PSA anxiety in both univariable and multivariable analysis.

RELATED: Docetaxel, Bevacizumab with ADT May Produce PSA Response

In addition, men with higher levels of health literacy were almost half as likely to undergo salvage ADT compared to those with low levels of health literacy in univariable analysis. They saw a trend toward this association in multivariable analysis.

“Given that early salvage ADT is costly, worsens quality of life, and has not been show to improve survival, quality improvement strategies are needed for these individuals,” the authors concluded.


  1. Mahal, B.A., et al. "High PSA anxiety and Low health literacy skills: drivers of early use of salvage ADT among men with biochemically recurrent prostate cancer after radiotherapy?" Annals of Oncology. doi: 10.1093/annonc/mdv185. [epub ahead of print]. April 28, 2015.

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