Marriage Has a Positive Effect on Prostate Cancer Outcomes

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ATLANTA—Being married is a plus when it comes to prostate cancer (PCa) outcomes, according to the findings of two studies presented at the American Urological Association 2012 annual meeting.

One study showed that men who have never been married may be at increased risk of PCa-specific and all-cause mortality following radical prostatectomy (RP). That study, by Kenneth Nepple, MD, and colleagues at Washington University School of Medicine in St. Louis, included 3,596 PCa patients treated with RP between 1994 and 2004 and followed for a median of 10.2 years. At the time of diagnosis, 86.9% of men were married, 5.3% were divorced, 2.4% were widowed, and 5.5% were never married.

Married men had the lowest mean PSA at diagnosis, and never married men were younger and the most likely to have no known medical comorbidity. Of the 441 men who died at the end of follow-up, only 65 died from PCa. Compared with married men, never-married men had a 2.63 times increased risk of PCa-related death and a 1.8 times increased risk of death from any cause, after controlling for age, PSA level, medical comorbidities, and other potential confounders. Divorced and widowed men were not at increased risk for either outcome compared with married men.

“While the retrospective nature of our analysis limits the ability to draw a causal inference between marital status and survival, there are several speculative reasons why never-married men were at higher risk for prostate cancer and overall mortality after prostatectomy,” Dr. Nepple told Renal & Urology News. “In never-married men, factors associated with social isolation, unhealthy behaviors, follow-up medical care, or unwillingness to receive adjuvant therapy may have a detrimental effect on survival after prostatectomy.”

Single men diagnosed with PCa may benefit from increased attention to PCa-related and general medical care and the patients' lifestyle decisions, such as alcohol use and smoking, he said.

In the other study, Mark D. Tyson, MD, and collaborators at Mayo Clinic in Phoenix, Ariz., demonstrated that unmarried men (single, divorced, separated, widowed) are at higher risk of PCa-specific mortality compared with married men of similar age, race, clinical stage, and tumor grade, even after accounting for competing causes of death.

The investigators analyzed data from 115,922 PCa cases reported to the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2003. Of these men, 78% were married and 22% were unmarried. Compared with married men, unmarried men had a 40% increased risk of PCa-specific mortality and a 51% increased risk in overall mortality, after controlling for age, clinical stage, tumor grade, and race. The five-year disease-specific survival for married men was 89.1% compared with 80.5% for unmarried men.

After further adjusting for competing causes of death, unmarried men had a 20% increased risk of PCa-specific mortality compared with married men.

According to Dr. Tyson, the study differs from previous investigations in that it accounts for all causes of mortality. “In cancer survival studies, it's difficult sometimes to identify the event of interest, and particularly in prostate cancer where it's such a long and protracted disease; other causes of mortality can influence someone's ability to measure statistically significant variables.”
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