The impact of social networks and partnership status on treatment choice in men with localized prostate cancer

OBJECTIVES To determine whether martial status and social support impact treatment choice. The decision to pursue radical prostatectomy for prostate cancer is often influenced by factors outside the realm of tumour risk, such as a man's support system at home. PATIENTS AND METHODS We performed a retrospective cohort study of 418 low-income men who were diagnosed with non-metastatic prostate cancer and underwent definitive treatment with either radical prostatectomy or radiotherapy. We performed univariate and multivariate mixed-effects logistic regression analysis, with the dependent variable being treatment type. Confidence intervals (CIs) for the predicted probabilities and relative risks were derived using bias-corrected bootstrapping with 1000 repetitions. RESULTS Men with two or more members in their support system were more likely to be older, Hispanic, have less than a high school education, earn more than US $1500 monthly, have high-risk disease and be in a significant relationship. In multivariate analysis, partnered men with fewer than two social support members (relative risk, RR, 1.23; 95% CI, 1.02-1.63) were more likely to undergo surgery, whereas men who were morbidly obese (RR, 0.46; 95% CI, 0.09-0.88), high school graduates (RR, 0.80; 95% CI, 0.64-0.99) or had high-risk disease (RR, 0.58; 95% CI, 0.44-0.85) were less likely to undergo surgery than their respective referent groups. Partnered men with two or more social support members were no more likely to undergo surgery than unpartnered men who lacked any social support. CONCLUSIONS In the present study cohort, married men with fewer than two members in their social network were more likely to have undergone surgery. Although marital status is often used as a proxy for social support, we find that the quality of support and partner may impact treatment type more than the extent of the social matrix.