Dr Stone on the Investigation of Limited English Proficiency and PSA Screening Rates in Prostate Cancer

Benjamin V. Stone, MD, fellow, urologic oncology, Massachusetts General Hospital, Brigham & Women’s Hospital, discusses clinical implications derived from a retrospective study on the effect of limited English proficiency on prostate-specific antigen (PSA) screening rates in American men with prostate cancer, as well as the need to improve equitable access to PSA screening across academic, and community centers.

In a retrospective study presented at the 2023 American Urological Association Annual Meeting, investigators collected data on PSA screening rates in patients who do not speak English as a first language. Patients were 55 years of age or older, and were stratified according to their level of English proficiency. Results showed that limited English proficiency was correlated with significantly lower rates of PSA screening, as patients who did not speak English well were less likely to undergo screening.

Although there are factors known to significantly influence screening behaviors, these results indicate that limited English proficiency may be a key driver of disparities in prostate cancer outcomes, Stone begins. Language barriers can prevent patients and practitioners from discussing the benefits and risks of PSA screening, limiting or preventing shared decision making, Stone explains. Additionally, limited English proficiency is associated with a higher incidence of advanced cancers at diagnosis, Stone adds.

Accordingly, efforts to address this disparity should implement strategies that focus on improving these patients' ability to navigate and access care, Stone states. For example, this could include the employment of cultural competency translators to ensure patients can make a fully informed decision, he says. Additionally, federal legislation has been enacted that mandates meaningful access to care for this patient population, Stone says. Overall, it is vital that adequate translator services be implemented across both major academic centers and in community settings, Stone emphasizes. This will allow patients to receive more equitable access to PSA screening regardless of location, Stone concludes.