title: Literacy, race, and PSA level among low-income men newly diagnosed with prostate cancer.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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. mswolf@northwestern.edu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Knight
authors.forename: E Allison
authors.initials: EA
authors.lastname: Lyons
authors.forename: Ramón
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.forename: Simon A
authors.initials: SA
authors.lastname: Pickard
authors.forename: Adnan
authors.initials: A
authors.lastname: Arseven
authors.forename: Ahsan
authors.initials: A
authors.lastname: Arozullah
authors.forename: Kathleen
authors.initials: K
authors.lastname: Colella
authors.forename: Paul
authors.initials: P
authors.lastname: Ray
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000368:Aged; D044383:Black People; D004522:Educational Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D012959:Socioeconomic Factors; D044465:White People; D001741:Black or African American
chemical_list: D017430:Prostate-Specific Antigen