title: Level of education and mortality after radical prostatectomy.
abstract: Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8-10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62-0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40-0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55-0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79-1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Froehner
authors.affiliation: Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Koch
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Propping
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Liebeheim
authors.affiliation: Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Hübler
authors.affiliation: Department of Pathology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Gustavo B
authors.initials: GB
authors.lastname: Baretton
authors.affiliation: Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055 Rostock, Germany.
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.affiliation: Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
authors.forename: Manfred P
authors.initials: MP
authors.lastname: Wirth
mesh_terms: D000368:Aged; D004522:Educational Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000401:mortality*; D016016:Proportional Hazards Models; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012923:Social Class