The association of marital status and mortality among men with early-stage prostate cancer treated with radical prostatectomy: insight into post-prostatectomy survival strategies

Purpose: The purpose of this study was to determine the association of marital status, a marker of social support, with all-cause and prostate cancer-specific mortality in a cohort of men with early-stage prostate cancer treated with radical prostatectomy. Methods: We conducted a retrospective cohort study of 3,579 men treated for localized (stage 1–2) prostate cancer with radical prostatectomy at a single institution between 1994 and 2004. Marital status (not married vs. married) and marital history (never married, divorced, widowed vs. married) at the time of prostatectomy were examined in relation to (1) all-cause mortality and (2) prostate cancer-specific mortality using Cox proportional hazards regression. Results: Not being married (vs. married) at the time of radical prostatectomy was associated with an increased risk of all-cause mortality [Hazard Ratio (HR) 1.42; 95% Confidence Interval (CI) 1.10, 1.85]. Similarly, in analyses of marital history, never-married men were at highest risk of all-cause mortality (HR 1.77, 95% CI 1.19, 2.63). Unmarried status (vs. married) was also associated with an increased risk of prostate cancer-specific mortality (HR 1.97; 95% CI 1.01, 3.83). Conclusions: Unmarried men with prostate cancer were at greater risk for death after radical prostatectomy. Among married men with prostate cancer, marriage likely serves as a multi-faceted proxy for many protective factors including social support. Future studies should explore the mechanisms underlying these findings to inform the development of novel prostate cancer survival interventions for unmarried men and those with low social support.