title: Socioeconomic status is an independent predictor of biochemical recurrence among patients with prostate cancer who undergo radical prostatectomy.
abstract: OBJECTIVE
  Socioeconomic status (SES) may influence cancer characteristics and behavior in several aspects. We analyzed PCa characteristics and behavior among low income uninsured men, and compare them to high income patients with health insurance in a developing country.
  
  
  METHODS
  A retrospective case-control study was performed on 934 patients with clinically localized PCa who underwent radical prostatectomy between March, 1999 and July, 2009. Patients were divided in two groups, according to their SES. In group 1 (n =380), all had low income, low educational levels and couldn ' t afford medical insurance. In group 2 (n =554), all had higher income, higher education and had medical insurance.
  
  
  RESULTS
  Patients from group 1 were older, had higher Gleason scores, higher rates of seminal vesicle and bladder neck involvement. The Kaplan Meier disease-free survival curve demonstrated that after a follow-up of four years, about 50% of uninsured patients had biochemical recurrence, versus 21% of insured patients (Log rank test: p < 0.001). A multivariate Cox regression analysis for the risk of disease recurrence demonstrated that only PSA levels, Gleason score, seminal vesicle involvement and SES were statistically significant variables. Patients with a low SES presented 1.8 times the risk of recurrence as compared to patients with a high SES.
  
  
  CONCLUSIONS
  Patients with low SES were older, presented more aggressive PCa characteristics and a high rate of disease recurrence. A low SES constituted an independent predictor for disease recurrence.
authors: Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
authors: Victor
authors: V
authors: Srougi
authors: Alberto A
authors: AA
authors: Antunes
authors: Sabrina T
authors: ST
authors: Reis
authors: Marcos F
authors: MF
authors: Dall'oglio
authors: Adriano J
authors: AJ
authors: Nesrallah
authors: Kátia R M
authors: KR
authors: Leite
authors: Miguel
authors: M
authors: Srougi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003906:Developing Countries; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012923:Social Class; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen