Awareness and Use of the Prostate-Specific Antigen Test: Results

Posted by James

Characteristics of non-Hispanic African-American men aged >45 (not suffering from prostate cancer) as determined from the NHIS sample are presented in Table 1. Approximately two-thirds were high-school graduates or above, more than half were from the south, and the majority resided in an MSA. Over half were married and had private and/or military insurance. Ninety-four percent had no first-degree family history of prostate cancer, and 69% had not been screened for colorectal cancer (Xeloda tablets is the only FDA-approved oral chemotherapy for both metastatic breast cancer and adjuvant and metastatic colorectal cancer). Most of these men also perceived themselves at low risk of getting cancer in general, and most perceived the amount of cancer in their own family to be low.

Table 2. Percentage of Non-Hispanic Black Men age 45 or Older Who Had Heard of a PSA Test or Who Had Ever Had a PSA Test by Population Subgroups

		Heard of PSA Test					Ever Had a PSA Test
	N	%a	Clb	GLC	Wald	N	%a	Clb	GLC	Wald
				PVC	PVd				PVC	PVd
All	681	63.2	58.8-67.5	674	47.7	43.7-51.7
Sociodemographics
Age (Years)
45 to 49	164	54.7	45.5-63.9	ref	0.07	163	29.3	22.1-36.5	ref	0.00
50 to 64	325	67.5	61.1-73.9	0.03	320	51.3	44.9-57.6	0.00
65+	192	64.5	57.5-7].5	0.08	191	54.7	46.7-62.7	0.00
Education
< High school graduate	242	46.3	39.8-52.7	ref	0.00	242	37.1	31.0-43.1	ref	0.00
High school graduate	195	70.5	63.1-77.9	0.00	191	52.6	45.1-60.1	0.00
Some college/tech school	148	76.7	69.5-83.9	0.00	145	59.6	49.4-69.8	0.00
College grad	88	80.9	72.9-88.9	0.00	88	49.4	38.2-60.6	0.04
Poverty Threshold
<200%	218	51.4	43.1-59.7	ref	0.00	217	39.9	31.9-48.0	ref	0.00
200-299%	105	58.1	47.4-68.8	0.30	103	42.6	33.2-51.9	0.68
300-399%	61	85.8	77.5-94.0	0.00	61	72.6	60.3-84.9	0.00
400-599%	46	70.2	60.5-79.9	0.00	46	59.8	47.6-72.0	0.01
500%+	105	77.9	68.3-87.5	0.00	102	60.6	50.9-70.4	0.00
Unknown	146	58.0	49.6-66.5	0.28	145	37.7	29.6-45.9	0.73
Region
Northeast	106	70.7	63.0-78.5	ref	0.20	103	54.2	45.8-62.6	ref	0.21
Midwest	116	56.4	48.0-64.9	0.02	116	41.5	32.4-50.5	0.04
South	397	62.2	56.5-67.9	0.08	395	46.3	41.3-51.4	0.12
West	62	61.7	49.4-74.0	0.22	60	48.3	35.2-61.3	0.45
Metropolitan Statistical Area
No	103	48.7	40.6-56.7	ref	0.00	102	37.9	31.3-44.6	ref	0.01
Yes	578	65.6	60.8-70.3	0.00	572	49.3	44.8-53.8	0.01
Family Composition
Marital Status
Married/living with partner 317		70.1	63.8-76.5	ref	0.01	314	54.2	47.9-60.5	ref	0.03
Widowed	73	62.0	48.1-75.9	0.28	73	53.4	35.6-71.1	0.93
Divorced or Separated	181	56.9	49.1-64.7	0.01	181	40.0	32.9-47.2	0.01
Never married	109	47.4	37.0-57.8	0.00	105	30.6	21.5-39.8	0.00
Family Size (Persons in Family)
1	318	53.2	47.7-58.7	ref	0.00	314	37.8	32.8-42.7	ref	0.00
2	217	68.5	61.8-75.2	0.00	215	52.3	45.8-58.8	0.00
3+	146	69.6	62.2-76.9	0.00	145	54.2	46.3-62.1	0.00
Family Structure
One adult no children	318	53.2	47.7-58.7	ref	0.00	314	37.8	32.8-42.7	ref	0.00
Multiple adults, no children 251		67.1	60.3-73.9	0.00	248	52.8	46.3-59.3	0.00
One adult, 1 + children	14	92.0	83.4-100	0.00	14	88.1	76.2-99.9	0.00
Multiple adults, 1+children 98		65.5	54.9-76.0	0.05	98	44.3	35.7-52.9	0.23

Overall, an estimated 63% of African-American men aged >45 who did not have prostate cancer (Casodex medication is an oral non-steroidal anti-androgen for prostate cancer) had heard of the PSA test, and 48% had had the PSA test (Table 2). For both having heard of the PSA test (N=681) and having had the test (N=674), significant associations were found in each of the four categories of variables. There were significant associations with all sociodemographic and family composition variables, all but one of the health status variables but none of the perceived risk variables. Specifically, being 50-64 years of age, having higher levels of education, higher incomes, living in the northeast versus the midwest, and residing in an MSA were associated with having heard of the PSA. Also, men who were married or living with their partners, men living in families of >2, men with private or military health insurance, men with a family history of prostate cancer, those who had been screened for colorectal cancer, and men with a high perceived amount of cancer (Nolvadex 20 mg treating breast cancer that has spread to other sites in the body) in their families were more likely to have heard of the PSA test than others. For ever having had a PSA test (Table 2, column 2), significant associations were similar with the exception that men >65 were also more likely to have had the PSA test. In adjusted analyses, men aged 50-64 years had twice the odds, and men >65 had more than three times the odds of having heard of the PSA test as men aged 45-59 (Table 3, column 1). The odds of having heard of the PSA test increased with each level of education over the reference group. Finally, men with private or military health insurance had more than twice the odds of having heard of the PSA test than men without health insurance.

Table 2 continued

		Heard of PSA Test					Ever Had a PSA Test
	N	%a	Clb	GLC	Wald	N	%a	Clb	GLC	Wald
				PVC	PVd				PVC	PVd
Health Status
Health Insurance
None	94	39.6	27.9-51.2	0.00	0.00	93	21.8	11.1-32.5	0.00	0.00
Public	171	49.0	38.9-59.2	0.00	169	39.5	30.1-48.8	0.00
Private/military	411	74.7	69.9-79.5	ref	407	58.2	52.9-63.6	ref
Health Status
Excellent	110	65.5	53.6-77.3	ref	0.72	109	46.5	35.6-57.4	ref	0.42
Very good	156	60.2	52.6-67.8	0.47	152	40.2	32.4-48.0	0.33
Good	225	66.1	59.0-73.3	0.93	224	51.0	44.0-58.0	0.49
Fair or poor	186	57.7	49.4-66.0	0.26	185	48.2	40.8-55.6	0.79
Fam/7y History of Prostate Cancer
Yes	42	76.0	64.3-87.7	0.03	0.04	42	64.2	52.0-76.4	0.01	0.02
No	625	62.0	57.4-66.7	ref	617	46.1	41.9-50.4	ref
Had Colorectal Screening*
Yes	138	85.4	78.9-91.9	0.00	0.00	137	81.9	74.8-89.1	0.00	0.00
No	362	58.0	52.3-63.7	ref	357	39.6	34.3-45.0	ref
Perceived Risk
Perceived Risk of Getting cancer
Low	399	63.9	58.2-69.5	ref	0.52	395	48.4	42.5-54.3	ref	0.81
Medium	140	64.2	56.4-72.1	0.93	139	48.6	39.7-57.5	0.98
High	48	63.2	49.7-76.8	0.93	46	51.0	37.3-64.7	0.74
Perceived Amount of Cancer in Family
Low	507	62.3	57 A-67.6	ref	0.14	501	47.5	42.1-52.9	ref	0.38
Medium	107	69.6	60.5-78.7	0.17	106	52.9	42.6-63.1	0.41
High	31	82.7	70.7-94.7	0.00	30	68.2	50.5-85.9	0.04

For ever having had the PSA test (Table 3 column 2), only one sociodemographic and three health status variables remained significant in the adjusted model. As expected, men 50-64 had over twice the odds and men aged >65 over four times the odds of ever having the PSA test as the referent (men aged 45-49). Men with private or military health insurance, those in fair or poor health, and those with a family history of prostate cancer were more likely than their referents to have had the test.

Table 3. Adjusted Odds Ratios of Non-Hispanic Black Mena Age 45 or Older Who Have Heard of a PSA Test or Having Been Tested, by Population Subgroups

	Have You Heard of a PSA Test?			Have You Ever Had a PSA Test?
		(n=560)			(n=553)
	Odds Ratio	Clb	Wald PVC	Odds Ratio	Clb      Wald PVC
Sociodemographics
Age (Years)
45 to 49	ref		0.00	ref	0.00
50 to 64	2.04	1.13-3.69		2.52	1.48-4.28
65+	3.31	1.88-5.83		4.44	2.29-8.61
Education
< High school graduate	ref		0.03	ref	0.11
High school graduate	1.88	1.04-3.41		1.28	0.72-2.30
Some college/tech school	2.33	1.17-4.67		2.25	1.16-4.40
College grad	3.07	1.23-7.64		1.39	0.68-2.87
Poverty Threshold
<200%	ref		0.17	ref	0.12
200-299%	0.61	0.31-1.21		0.54	0.24-1.19
300-399%	2.37	1.01-5.60		1.97	0.82-4.73
400-599%	1.03	0.36-2.99		1.37	0.51-3.66
500%+	1.25	0.54-2.91		1.05	0.46-2.39
Unknown	1.03	0.56-1.91		0.82	0.45-1.50
Region
Northeast	ref		0.49	ref	0.53
Midwest	0.70	0.27-1.82		0.61	0.29-1.30
South	0.87	0.37-2.05		0.73	0.38-1.42
West	0.47	0.15-1.50		0.53	0.18-1.52
Metropolitan Statistical Area
No	ref		0.05	ref	0.24
Yes	1.76	1.00-3.09		1.47	0.78-2.78
Family Composition
Marital Status
Married/living with partner	ref		0.64	ref	0.28
Widowed	0.77	0.31-1.90		1.37	0.53-3.55
Divorced or Separated	1.25	0.52-3.02		1.55	0.65-3.69
Never married	1.05	0.38-2.89		0.80	0.21-3.12
Family Size (Persons in Family)
1	ref		0.47	ref	0.42
2	1.62	0.73-3.62		1.69	0.77-3.72
3+	1.37	0.54-3.51		1.76	0.64-4.86