title: High incidence of prostate cancer metastasis in Afro-Brazilian men with low educational levels: a retrospective observational study.
abstract: BACKGROUND
  This study investigated factors related to ethnicity and educational level, their correlation with tumor stage at the time of diagnosis, and their influence on treatment outcomes in patients with prostate cancer.
  
  
  METHODS
  In this retrospective observational study, we analyzed the medical records of 1,349 male patients treated for prostatic adenocarcinoma. We collected information about sociodemographic variables, including educational level and self-reported skin color. We also classified the disease according whether it was to more likely to present with metastasis and measured the tumor response to treatment.
  
  
  RESULTS
  Less-educated (<8 years of education) individuals were 4.8 times more likely to develop metastasis than those with more education (>11 years of education; p < 0.001). Similarly, patients with a self-reported black skin color had a 300% increased risk of metastasis at diagnosis (p = 0.001). Distant metastasis was independently correlated with worse outcomes, such that individuals with distant metastasis were 10 times more likely to die than were those without distant metastasis.
  
  
  CONCLUSIONS
  Patients with self-reported black skin color and <8 years of education were more likely to display advanced disease at the time of diagnosis compared with their counterparts. Only the presence of metastasis was independently associated with mortality or progressive disease.
authors.forename: Alexandre Barbosa Câmara
authors.initials: AB
authors.lastname: de Souza
authors.forename: Hugo Gonçalo
authors.initials: HG
authors.lastname: Guedes
authors.forename: Victor Carbone Bernardes
authors.initials: VC
authors.lastname: Oliveira
authors.forename: Fábio Aires
authors.initials: FA
authors.lastname: de Araújo
authors.forename: Carlos Cesar Oliveira
authors.initials: CC
authors.lastname: Ramos
authors.forename: Karina Carla Paula
authors.initials: KC
authors.lastname: Medeiros
authors.affiliation: Department of Morphology, Federal University of Rio Grande do Norte, Natal 59072-970, Rio Grande do Norte, Brazil. araujojr@cb.ufrn.br.
authors.forename: Raimundo Fernandes
authors.initials: RF
authors.lastname: Araújo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D004522:Educational Status; D005006:Ethnicity; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies; D012923:Social Class