Socioeconomic Predictors and Patient Perspectives of Prostate-specific Antigen Testing

Abstract

Objective: To identify important factors affecting men's decision to undergo prostate-specific antigen (PSA) testing and to determine who is at risk for prostate cancer based on age-specific PSA values. Materials and Methods: We retrospectively analyzed data obtained from 4963 men aged between 40-80 years. Between 2010 and 2017, participants from rural districts of Izmir, Turkey were invited to join a free public health screening program including brief health history assessment, anthropometric measurements, and blood and urine analyses. Participants completed a questionnaire regarding educational level, marital status, economic status, and previous PSA tests, and venous blood samples were obtained for PSA testing. Results: All 4963 men were included in the study. The majority of the participants had low education level and low or very low socioeconomic status. Nearly all of the subjects stated that their main reason for participating in the screening program was it was a free, regular health check-up program and was easily accessible in their hometown. Urinary complaints were present in 28% of the participants. Of the screened men, PSA level was >= 2 ng/mL in 21.1% and >= 4 ng/mL in 7.7%. Of the subjects with previous PSA tests, 77.5% were referred for either biopsy or further testing, but due to financial and transportation difficulties, only 7% of them followed-up at a hospital or urology department. Conclusion: Economic factors determine men's attitude towards PSA testing. Specific measures should be taken to overcome factors that hinder the early detection of prostate cancer.