BACKGROUND In prostate cancer (PCa), lower education level is associated with less screening, more advanced stage at diagnosis and worse survival. The aim of this study was to estimate the association between education level and treatment modality and subsequently survival. METHODS The 9255 men diagnosed with PCa in the Finnish Randomized Study of Screening for Prostate Cancer were included. Cancer stage, comorbidity, education level and primary treatment modality were extracted from the patient records, the Finnish Cancer Registry, Statistics Finland and the National Institute of Health and Welfare, and these covariates were used in logistic regression (treatment selection) and Cox regression (survival analysis). RESULTS In high-risk cancers, men with tertiary education were more likely to be treated with radical prostatectomy (odds ratio [OR] = 1.76; 95% confidence interval [CI] = 1.27-2.44) than men with primary education. Men with secondary (OR = 0.57; 95% CI = 0.38-0.84) or tertiary (OR = 0.42; 95% CI = 0.29-0.60) education were managed less frequently with mere hormonal therapy. In locally advanced cases, tertiary education was associated with more curatively aimed therapies and less hormonal therapy (OR for radical prostatectomy = 2.34; 95% CI = 1.49-3.66; OR for radiotherapy = 1.42; 95% CI = 1.09-1.85; OR for hormonal therapy = 0.45; 95% CI = 0.33-0.60). The hazard ratio for PCa death was lower in men with secondary (0.81; 95% CI = 0.69-0.95) and tertiary (0.75; 95% CI = 0.65-0.87) education than in the patients with primary education. CONCLUSIONS When controlled for the cancer risk group, comorbidity and patient's age, low education level is independently associated with less curatively aimed treatment in men with high-risk or locally advanced PCa and subsequently worse prognosis.

中文翻译：

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在芬兰筛查前列腺癌的随机研究中，患者对前列腺癌的教育水平和治疗方式。

背景技术在前列腺癌（PCa）中，较低的教育水平与较少的筛查，较高的诊断阶段和较差的存活率相关。这项研究的目的是估计教育水平和治疗方式与随后生存之间的关联。方法纳入芬兰前列腺癌筛查随机研究中的9255名被诊断为PCa的男性。从患者记录，芬兰癌症登记处，芬兰统计局和美国国立卫生与福利研究院提取癌症阶段，合并症，教育水平和主要治疗方式，并将这些协变量用于logistic回归（治疗选择）和Cox回归（生存分析）。结果在高危癌症中，大专以上学历的男性比初等学历的男性更有可能接受前列腺癌根治术（几率[OR] = 1.76； 95％置信区间[CI] = 1.27-2.44）。受过中等（OR = 0.57; 95％CI = 0.38-0.84）或专上教育（OR = 0.42; 95％CI = 0.29-0.60）的男性接受激素治疗的频率较低。在局部晚期病例中，高等教育与更有针对性的治疗和较少的激素治疗相关（根治性前列腺切除术的OR = 2.34； 95％CI = 1.49-3.66； OR放射治疗= 1.42； 95％CI = 1.09-1.85； OR激素疗法= 0.45； 95％CI = 0.33-0.60）。接受过中等教育的男性（0.81； 95％CI = 0.69-0.95）和高等教育（0.75； 95％CI = 0.65-0.87）的男性PCa死亡危险率低于接受初等教育的男性。