Social Disparities in Survival from Prostate Cancer in Europe

Abstract

Social disparities that influence the survival of prostate cancer patients in Europe are probably more clearly understood under the umbrella term of socioeconomic status (SES). Measuring SES is as difficult as quantifying a concept like quality of life (QoL). However, QoL has different instruments that have been well validated over the years, while similar instruments do not exist in the case of SES. At present, only the European Deprivation Index (EDI) that was developed by the European Union Statistics on Income and Living Conditions (EU-SILC) can be an appropriate candidate to measure SES for future studies.

Previous reports of different cancer locations suggest lower survival among socioeconomically disadvantaged groups of patients. As prostate cancer has been associated with high socioeconomic income, few studies have addressed SES and survival in this group of patients.

Despite the apparent economic uniformity in European countries, large disparities exist when comparing economic resources, level of education and access to public health systems. Prostate cancer survival is closely associated with patients’ risk categories combining tumour extension, the value of PSA and Gleason score. Therefore, any factor associated with a diagnostic delay is likely to be detrimental for survival. European areas with higher SES usually have easier access to PSA testing and, consequently, increased diagnosis of cases with a low tumour burden. Different concepts have been proposed to measure SES. However, EDI could be a good instrument to homogenise this measurement in epidemiological studies in the future. In Europe, only one study that has addressed the issue of SES and survival focused exclusively on prostate cancer. In the rest of the publications, prostate cancer is only a part of a group of tumours studied. In summary, in European countries, an increase in the incidence of prostate cancer with better survival has been shown in high-SES populations. The increasing use of PSA testing, particularly among high SES populations, could be the cause.