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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.
Acknowledgements
We sincerely thank the Karolinska University Laboratory, Aleris Medilab, Unilabs and the Regional Prostate Cancer Registry for performing analyses and helping to retrieve data. Carin Cavalli-Björkman and Britt-Marie Hune are thanked for their enthusiastic work as research nurses. We also acknowledge our data administrator Astrid Björklund for helping with dataset compilation.
Declaration of interest
No competing interests declared.
This study was supported by grants from the Strategic Research Programme on Cancer [StratCan], Karolinska Institutet; the Linné Centre for Breast and Prostate Cancer [CRISP, 70867901], Karolinska Institutet; the Swedish Research Council [K2010-70X-20430-04-3]; the Swedish Cancer Society [11-0287; 2012-475]; and Stiftelsen Johanna Hagstrand och Sigfrid Linners Minne. The funding sources had no role in the study design; collection, analysis or interpretation of data; writing of the report; or the decision to submit the article for publication. The researchers were all independent from the funding source.