Introduction: Prostate cancer remains the most common cancer diagnosed in males. Limited evidence is available regarding health literacy and its association with prostate specific antigen screening rates (PSA). Our objective was to assess if such association exists.

Methods: This retrospective cross-sectional study utilized the 2016 Behavioral Risk Factor Surveillance System (BRFSS). Our primary exposure was self-reported health literacy, which was determined by a cumulative score (3-15) of three survey questions. The primary outcome was whether patients underwent PSA testing. Males 55-69 years old were included. Unadjusted and adjusted logistic regression analysis were used to calculate odds ratios (OR) and 95% confidence intervals (CI). Additional analysis of the most significant covariates was conducted to determine presence of effect modification of our primary association.

Results: Our final sample included 12,149 men. Patients reported health literacy levels of low, moderate and high at 5%, 54% and 41%, respectively. Compared with participants who reported high levels of health literacy, odds of a PSA test were 59% lower for men with low health literacy (OR 0.41; 95% CI 0.28, 0.64). The corresponding OR for those with moderate health literacy level was 0.70 (95%CI 0.60, 0.83). Increased age, Black/African American race, Hispanic ethnicity, smoking history, elevated BMI, health insurance, high school education or greater, annual income above $50,000, and marriage were positively associated with PSA testing. Secondary analysis revealed that race did not modify our primary association; however, modification was present in subjects with income >$50,000 and those who attended college/tech school.

Conclusion: Our research demonstrates a positive association between self-reported health literacy and the likelihood of PSA screening. Thus, patients who feel as if they can access and understand health information are more likely to be involved in their own urologic preventive care. Future studies examining how health literacy affects other urologic conditions are necessary.