Individual- and neighborhood-level education influences the effect of obesity on prostate cancer treatment failure after prostatectomy

PURPOSE - The relationship between obesity and prostate cancer (CaP) treatment failure is complex and may vary by patient- and neighborhood-level educational attainment. We evaluated whether patient- and neighborhood-level education is associated with the effect of obesity on biochemical recurrence.

METHODS - Seven hundred and forty-six CaP cases were classified into four groups: Concordant Low-Low: less educated cases (<4 years college) living in a less educated neighborhood (below-median proportion of college-educated residents; n = 164); Concordant High-High: highly educated cases (≥4 years college) living in a highly educated neighborhood (above-median proportion of college-educated residents; n = 326); Discordant Low-High: less educated cases living in a highly educated neighborhood (n = 69); and Discordant High-Low: highly educated cases living in a less educated neighborhood (n = 187). Cox regression models were used to examine associations between obesity and biochemical (PSA) failure after prostatectomy stratified by the concordant/discordant groups.

RESULTS - The association of obesity with biochemical failure varied significantly by educational concordance/discordance (p = 0.007). Obesity was associated with risk of biochemical failure for less educated cases residing in less educated neighborhoods (HR 3.72, 95 % CI 1.30-10.65). The relationship was not significant for other concordant/discordant groups.

CONCLUSIONS - Obesity effects on CaP outcomes vary by multilevel educational discordance/concordance. Strategies to decrease prostate cancer risk of progression may focus on reduction in obesity, particularly for less educated cases residing in less educated neighborhoods.

Cancer Causes Control. 2015 Jul 14. [Epub ahead of print]

Zeigler-Johnson C1, Morales KH, Glanz K, Spangler E, Mitchell J, Rebbeck TR.

Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA

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