Wolf Michael S, Knight Sara J, Lyons E Allison, Durazo-Arvizu Ramón, Pickard Simon A, Arseven Adnan, Arozullah Ahsan, Colella Kathleen, Ray Paul, Bennett Charles L
Robert H. Lurie Comprehensive Cancer Center, Institute for Healthcare Studies and Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Urology. 2006 Jul;68(1):89-93. doi: 10.1016/j.urology.2006.01.064.
Among men with newly diagnosed prostate cancer, prostate-specific antigen (PSA) levels are higher and the cancer stage more advanced for African Americans than for whites. An earlier study found that after adjustment for literacy, race was no longer a significant predictor of advanced stage at presentation. We investigated whether, after adjusting for literacy, race was a significant independent predictor of greater PSA levels among men with newly diagnosed prostate cancer.
Consecutive patients with newly diagnosed prostate cancer from four outpatient care facilities in Chicago were interviewed and given a literacy assessment (n = 308). The PSA level at diagnosis was obtained from the medical charts. Logistic regression models were used to identify predictors of high PSA levels (greater than 20 ng/mL) at presentation.
African-American men were three times more likely to have low literacy skills (sixth grade or less: 22.9% versus 7.1%; P <0.001) than were white men. In turn, men with low literacy skills were more than twice as likely to have a PSA level greater than 20 ng/mL at diagnosis (33.3% versus 13.5%; P = 0.009). On multivariate analyses, significant predictors of high PSA levels included low literacy (adjusted odds ratio 2.5, 95% confidence interval 1.5 to 4.2) and older age (age 65 to 74 years, adjusted odds ratio 2.6, 95% confidence interval 2.1 to 3.1 versus older than 74 years, adjusted odds ratio 3.4, 95% confidence interval 1.8 to 6.6), but not African-American race.
In the current era in which PSA testing is common, low literacy may be an important and potentially overlooked factor associated with higher PSA levels at prostate cancer diagnosis among African-American and white men.
在新诊断出前列腺癌的男性中，非裔美国人的前列腺特异性抗原（PSA）水平更高，癌症分期也比白人更晚。一项早期研究发现，在对识字率进行调整后，种族不再是就诊时癌症晚期的显著预测因素。我们调查了在对识字率进行调整后，种族是否是新诊断出前列腺癌的男性中PSA水平更高的显著独立预测因素。
对来自芝加哥四个门诊护理机构的新诊断出前列腺癌的连续患者进行访谈，并进行识字评估（n = 308）。从病历中获取诊断时的PSA水平。使用逻辑回归模型来确定就诊时PSA水平高（大于20 ng/mL）的预测因素。
非裔美国男性识字技能低（六年级及以下：22.9% 对7.1%；P <0.001）的可能性是白人男性的三倍。相应地，识字技能低的男性在诊断时PSA水平大于20 ng/mL的可能性是识字技能高的男性的两倍多（33.3% 对13.5%；P = 0.009）。在多变量分析中，PSA水平高的显著预测因素包括识字率低（调整后的优势比为2.5，95%置信区间为1.5至4.2）和年龄较大（65至74岁，调整后的优势比为2.6，95%置信区间为2.1至3.1；74岁以上，调整后的优势比为3.4，95%置信区间为1.8至6.6），但不包括非裔美国人种族。
在当前PSA检测很普遍的时代，识字率低可能是一个重要且可能被忽视的因素，与非裔美国人和白人男性前列腺癌诊断时较高的PSA水平相关。
