Health risk behaviors associated with lower prostate specific antigen awareness

August 2008 -- According to a study conducted at Columbia University Mailman School of Public Health, health risk behaviors such as smoking and obesity are associated with lower awareness of the Prostate Specific Antigen (PSA), which could lead to a lower likelihood of undergoing actual prostate cancer screening. Although previous studies have explored predictors of PSA test awareness, this is the first research to focus on health risk behaviors, such as smoking, physical inactivity, obesity, and excessive alcohol consumption. The study findings were reported in the August issue of The Journal of Urology.

Awareness of PSA testing is considered an important cognitive precursor of prostate cancer screening and it was found to contribute to differences in prostate cancer screening rates. Earlier studies have suggested that persons who seek out cancer information are more likely to acquire knowledge, demonstrate healthy behaviors, and undergo cancer screening. According to the Mailman School study, a quarter of the men older than 50 years without a history of prostate cancer who were among the population of 7,000 men studied, remain unaware of the PSA test.

"Our primary findings suggested that smoking, physical inactivity and obesity are inversely associated with awareness of the PSA test. These risk behaviors are linked with higher prostate cancer morbidity and mortality," said Firas S. Ahmed, MD, MPH, Mailman School of Public Health, and first author. This finding may be due to a general lack of concern about health maintenance or less interactions with health care providers by smokers, according to Dr. Ahmed.

The earlier research also indicated that patients with prostate cancer who smoke present a worse prognosis than patients who do not smoke, and that obesity is associated with more advanced stages and higher grades of prostate cancer.

"The results concur with our initial hypothesis that men who adopt unhealthy lifestyles may be less concerned with health and less aware of preventive measures like the PSA test," says Luisa N. Borrell, DDS, PhD, adjunct assistant professor in the Mailman School of Public Health's Department of Epidemiology, and senior author. Given the associations between smoking, physical inactivity, and obesity with prostate cancer and cardiovascular disease, men with multiple risk behaviors would seem to be ideal targets for interventions to improve their awareness of the PSA test, the authors note.

The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 1000 graduate students in pursuit of masters and doctoral degrees. Its students and more than 300 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences. www.mailman.columbia.edu