High PSA anxiety and low health literacy skills: drivers of early use of salvage ADT among men with biochemically recurrent prostate cancer after radiotherapy?
BACKGROUND
Although commonly used, early initiation of salvage androgen deprivation therapy (ADT) has not been proven to enhance survival. We evaluated whether prostate-specific antigen (PSA) anxiety or health literacy are associated with use of early salvage ADT among men with recurrent prostate cancer after radiotherapy.


METHODS
The prospective Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma Registry was used to study 375 men with biochemically recurrent prostate cancer after external beam radiation or brachytherapy. Multivariable logistic regression was used to determine whether PSA anxiety and health literacy are associated with salvage ADT as initial management after biochemical recurrence.


RESULTS
Sixty-eight men (18.1%) received salvage ADT as initial management for PSA recurrence. Men with high PSA anxiety were twice as likely to receive salvage ADT compared with men who did not have high PSA anxiety on both univariable [28.8% versus 13.1%; odds ratio (OR) 2.15; 95% confidence interval (CI) 1.16-4.00; P = 0.015] and multivariable analysis [adjusted OR (AOR) 2.36; 95% CI 1.21-4.62; P = 0.012]. Furthermore, men who had higher levels of health literacy were nearly half as likely to undergo salvage ADT compared with men who had lower levels of health literacy on univariable analysis (15.2% versus 26.3%; OR 0.50; 95% CI 0.29-0.88; P = 0.016), with a trend toward this association on multivariable analysis (AOR 0.58; 95% CI 0.32-1.05; P = 0.07).


CONCLUSIONS
Among men with PSA recurrence after radiotherapy, odds of use of salvage ADT were nearly twice as great among men with high PSA anxiety or low health literacy, suggesting that these men are receiving higher rates of unproven treatment. Given that early salvage ADT is costly, worsens quality of life, and has not been shown to improve survival, quality improvement strategies are needed for these individuals.
Harvard Medical School, Boston.
B A
BA
Mahal
Department of Statistics, University of Connecticut, Storrs.
M-H
MH
Chen
South Carolina College of Pharmacy and the Hollings Cancer Center, Charleston.
C L
CL
Bennett
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland.
M W
MW
Kattan
Departments of Medicine and Urology, Tulane University, New Orleans.
O
O
Sartor
Novartis, East Hanover.
K
K
Stein
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
A V
AV
D'Amico
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, USA pnguyen@LROC.harvard.edu.
P L
PL
Nguyen
D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy / Q000523:psychology / Q000532:radiotherapy; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D001918:Brachytherapy / Q000009:adverse effects; D005500:Follow-Up Studies; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000523:psychology / Q000532:radiotherapy; D011788:Quality of Life; D016879:Salvage Therapy
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen
androgen deprivation therapy; health policy; prostatic neoplasm; recurrence; salvage therapy