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Scand J Urol. 2016;50(2):104-9. doi: 10.3109/21681805.2015.1113200. Epub 2015 Dec 1.

A population-based study on the association between educational length, prostate-specific antigen testing and use of prostate biopsies.

Author information

1
a Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden ;
2
b Department of Clinical Sciences at Danderyd Hospital , Karolinska Institutet , Stockholm , Sweden ;
3
c Department of Urology , Helen Diller Family Comprehensive Cancer Center, University of California , San Francisco , CA , USA ;
4
d Urological Cancer Research Unit, Department of Translational Medicine , Lund University , Lund , Sweden ;
5
e Department of Urology , Cambridge University Hospitals , Cambridge , UK ;
6
f Karolinska Institutet , Department of Clinical Science, Intervention and Technology (CLINTEC) , Stockholm , Sweden ;
7
g Swedish Council for Health Technology Assessment , Stockholm , Sweden.

Abstract

OBJECTIVE:

The aim of this study was to determine whether educational length affects prostate-specific antigen (PSA) testing and the time to prostate biopsy for men with raised PSA values.

MATERIALS AND METHODS:

Using register data on all men in Stockholm County in 2013 (n = 1,052,841), the limited-duration point prevalence of PSA testing and time between test and prostate biopsy or repeat testing were analysed. Patterns of follow-up were assessed using Kaplan-Meier product limit estimators and Cox proportional hazard models. Educational length was categorized as short (≤ 9 years), intermediate (10-12 years) or long (≥ 13 years).

RESULTS:

PSA testing increased with educational length in all age groups. Among men aged 50-69 years, 61% with long and 54% with short education had had a PSA test within the preceding 10 years (p < 0.001). In men with PSA 4-10 ng/ml, 40% [95% confidence interval (CI) 38-41] with long and 27% (95% CI 26-29) with short education underwent a prostate biopsy within 12 months. After adjusting for PSA level and age, educational length was still associated with the chance of having a prostate biopsy in men with PSA 4-10 ng/ml (hazard ratio 1.22, 95% CI 1.12-1.31), but not in men with higher PSA values.

CONCLUSION:

PSA testing increased with educational length. Men with long education were more likely to have a prostate biopsy after an increased PSA value below 10 ng/ml than men with short education. These differences may contribute to the worse prostate cancer outcomes observed among men with lower socioeconomic status.

KEYWORDS:

Diagnosis; epidemiology; population-based studies; prostate cancer; prostate-specific antigen (PSA); socioeconomic status

PMID:
26625178
DOI:
10.3109/21681805.2015.1113200
[Indexed for MEDLINE]

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