Socioeconomic determinants of prostate-specific antigen testing and estimation of the prevalence of undiagnosed prostate cancer in an elderly Polish population based on the PolSenior study.
BACKGROUND
Socioeconomic determinants of prostate-specific antigen (PSA) testing and prevalence of undiagnosed prostate cancer (PCa) in the Polish population are poorly understood. The aim of this study was to identify factors associated with PSA testing in elderly Polish men, and estimate the size of the population at risk of PCa related to PSA non-testing.


METHODS
We analyzed questionnaire-derived data concerning PSA testing, obtained in 2567 elderly and 332 younger (age: 55-59) participants of the population-based PolSenior study. Additionally, PSA was measured in 2414 subjects.


RESULTS
The PSA had previously been tested in 41.2% of elderly and in 24.8% of younger participants. Non-smoking status (OR = 2.06,p< 0.001), higher personal income (OR = 1.56,p< 0.001), better education (OR = 1.49,p= 0.001), previous white-collar work (OR = 1.37,p= 0.005), alcohol abstinence (OR = 1.28,p= 0.02), married status (OR = 1.24,p= 0.04), dependence in Instrumental Activities of Daily Living (IADL) but not in Activities of Daily Living (ADL) (OR = 0.65,p< 0.001), and dependence in ADL (OR = 0.55,p< 0.001) were independent predictors of previous PSA testing in elderly participants. There were 31 elderly previously treated for PCa (calculated standardized prevalence: 935 per 100,000 elderly population). The PSA levels > 4 ng/ml were found in 12.8% of 65-74-year-old and 4.5% of 55-59-year-old previously non-tested participants. We calculated the standardized prevalence rate of undiagnosed PCa as approximately 1370 and 2352 cases per 100,000 population aged 55-59 and 65-74 years, respectively.


CONCLUSIONS
In Poland, 58.8% of elderly men have never had PSA tested. These were less likely to be functionally independent, married, better educated, non-smokers or to have previous office employment or higher than average personal income. Our data suggest substantial underdiagnosis of prostate cancer among Polish men.
Department of Urology, Medical Faculty, Medical University of Silesia, Katowice, Poland.
Andrzej
A
Prajsner
Department of Pathophysiology, Medical Faculty, Medical University of Silesia, Katowice, Poland; Department of Nephrology, Transplantation and Internal Medicine, Medical Faculty, Medical University of Silesia, Katowice, Poland.
Jerzy
J
Chudek
International Institute of Molecular and Cell Biology, Warsaw, Poland.
Aleksandra
A
Szybalska
Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
Karolina
K
Piotrowicz
Department of Epidemiology, Medical Faculty, Medical University of Silesia, Katowice, Poland.
Jan
J
Zejda
Department of Nephrology, Transplantation and Internal Medicine, Medical Faculty, Medical University of Silesia, Katowice, Poland.
Andrzej
A
Więcek
epidemiology; prostate cancer screening; prostate-specific antigen; screening
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