Steenland Kyle, Rodriguez Carmen, Mondul Alison, Calle Eugenia E, Thun Michael
Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
Cancer Causes Control. 2004 Nov;15(9):939-45. doi: 10.1007/s10552-004-2231-5.
There are few data on prostate cancer incidence and survival in relation to socioeconomic status in the 1990s, after the introduction of prostate specific Antigen (PSA) testing.
We studied the relation of education to prostate cancer incidence and survival in the Cancer Prevention Study II (CPS-II) Nutrition Cohort. Participants provided questionnaire data on diet, medical history, education, and PSA testing. We followed 72,449 men from 1992-1999 for cancer incidence (4279 incident cases), and through 2000 for survival (158 prostate cancer deaths among incident cases).
Multivariate-adjusted rate ratios (RRs) were calculated using Cox proportional hazards models. Self-reported (PSA) tests were more common among the more highly educated. Men with at least a college education had a 15-19% higher prostate cancer incidence than those with a high school education or less, but this association was limited to localized cancers and was attenuated by adjustment for PSA testing. Survival analysis among incident prostate cancer cases adjusted for stage and grade at diagnosis showed much lower prostate cancer mortality for men with at least a high school education compared to those with less than a high school education (RR = 0.49, 95% CI = 0.32-0.76).
This study suggests that higher education is associated with slightly increased incidence of prostate cancer, at least partly due to greater use of PSA screening and a greater detection of localized tumors among more highly educated men. The much lower survival rates from prostate cancer among those with less than a high school education cannot be explained by available data and may reflect disparities in treatment. In 1999, 27% of US males over age 55 and older had less than a high school education.
在引入前列腺特异性抗原（PSA）检测后，关于20世纪90年代前列腺癌发病率及生存率与社会经济地位关系的数据较少。
我们在癌症预防研究II（CPS-II）营养队列中研究了教育程度与前列腺癌发病率及生存率的关系。参与者提供了有关饮食、病史、教育程度和PSA检测的问卷数据。我们从1992年至1999年对72449名男性进行随访以了解癌症发病率（4279例发病病例），并随访至2000年以了解生存率（发病病例中有158例前列腺癌死亡）。
使用Cox比例风险模型计算多变量调整后的率比（RRs）。自我报告的（PSA）检测在受教育程度较高者中更为常见。至少拥有大学学历的男性前列腺癌发病率比高中学历或更低学历者高15 - 19%，但这种关联仅限于局限性癌症，且在对PSA检测进行调整后减弱。对诊断时的分期和分级进行调整后的前列腺癌发病病例生存分析显示，至少拥有高中学历的男性与高中以下学历者相比，前列腺癌死亡率要低得多（RR = 0.49，95%CI = 0.32 - 0.76）。
本研究表明，高等教育与前列腺癌发病率略有增加相关，至少部分原因是受教育程度较高的男性更多地使用PSA筛查以及更多地检测到局限性肿瘤。高中以下学历者前列腺癌生存率低得多的情况无法用现有数据解释，可能反映了治疗方面的差异。1999年，美国55岁及以上男性中有27%的人学历低于高中。
