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IMPACT OF EDUCATIONAL LEVEL ON DECISION-MAKING IN LOW-RISK PROSTATE CANCER PATIENTS IN PUERTO RICO: A VALIDATED QUESTIONNAIRE-BASED COMPARATIVE STUDY
Ana Sofía Velázquez López, ScM1, Guillermo Gonzalez Figueroa, MD2.
1UMass Chan, Worcester, MA, USA, 2St Lukes Episcopal Hospital, Ponce, PR, USA.
Active surveillance (AS) is the preferred management for low-risk prostate cancer per AUA guidelines, preserving quality of life without compromising oncologic safety. Despite increasing adoption, disparities in uptake persist, often attributed to patient education, health literacy, and misconceptions about treatment efficacy. Understanding these factors in diverse populations, including Puerto Rican patients, is essential to improving equitable decision-making.We conducted a cross-sectional study of 61 men aged 45-75 with biopsy-proven low-risk prostate cancer (98.4% T1c, 1.6% T2a) from urology practices in southern Puerto Rico. Participants completed validated questionnaires assessing education level, health literacy, prostate cancer knowledge, attitudes toward AS, and satisfaction with decision-making. Treatment selection (AS vs. external beam radiotherapy [EBRT] or robot-assisted radical prostatectomy [RARP]) was documented. Comparative analyses were performed using chi-square and Mann-Whitney U tests. Logistic regression evaluated predictors of AS selection.Of 61 participants, 46 (75.4%) chose AS, 7 (11.5%) EBRT, and 8 (13.1%) RARP. Academic level and health literacy were not associated with treatment selection (p>0.05). Prostate cancer knowledge showed no significant association, except for the belief that “surgery always cures prostate cancer,” which was linked to lower AS uptake (p=0.046). Satisfaction with decision-making was high across groups. Median satisfaction scores were slightly higher in the treatment group than AS (51.5 vs. 46.0; p=0.169). Logistic regression revealed that comfort with delaying treatment strongly predicted AS choice: patients who felt “very uncomfortable” delaying treatment were 96% less likely to pursue AS (OR=0.037, p=0.012)Educational level and general health literacy were not independent predictors of AS selection in this Puerto Rican cohort. Instead, misconceptions about treatment efficacy and personal comfort with delaying therapy exerted stronger influence. These findings highlight the importance of targeted counseling to address anxiety and correct misconceptions, reinforcing the central role of providers in promoting guideline-concordant care.
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