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Marital status and prostate cancer incidence: a pooled analysis of 12 case–control studies from the PRACTICAL consortium

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Abstract

While being in a committed relationship is associated with a better prostate cancer prognosis, little is known about how marital status relates to its incidence. Social support provided by marriage/relationship could promote a healthy lifestyle and an increased healthcare seeking behavior. We investigated the association between marital status and prostate cancer risk using data from the PRACTICAL Consortium. Pooled analyses were conducted combining 12 case–control studies based on histologically-confirmed incident prostate cancers and controls with information on marital status prior to diagnosis/interview. Marital status was categorized as married/partner, separated/divorced, single, or widowed. Tumours with Gleason scores ≥ 8 defined high-grade cancers, and low-grade otherwise. NCI-SEER’s summary stages (local, regional, distant) indicated the extent of the cancer. Logistic regression was used to derive odds ratios (ORs) and 95% confidence intervals (CI) for the association between marital status and prostate cancer risk, adjusting for potential confounders. Overall, 14,760 cases and 12,019 controls contributed to analyses. Compared to men who were married/with a partner, widowed men had an OR of 1.19 (95% CI 1.03–1.35) of prostate cancer, with little difference between low- and high-grade tumours. Risk estimates among widowers were 1.14 (95% CI 0.97–1.34) for local, 1.53 (95% CI 1.22–1.92) for regional, and 1.56 (95% CI 1.05–2.32) for distant stage tumours. Single men had elevated risks of high-grade cancers. Our findings highlight elevated risks of incident prostate cancer among widowers, more often characterized by tumours that had spread beyond the prostate at the time of diagnosis. Social support interventions and closer medical follow-up in this sub-population are warranted.

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Availability of data and material

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy and ethical restrictions.

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Acknowledgements

The PRACTICAL consortium. This work was supported by the Canadian Institutes of Health Research, European Commission's Seventh Framework Programme Grant Agreement No. 223175 (HEALTH-F2-2009-223175), Cancer Research UK Grants C5047/A7357, C1287/A10118, C1287/A16563, C5047/A3354, C5047/A10692, C16913/A6135, and The National Institute of Health (NIH) Cancer Post-Cancer GWAS initiative Grant: No. 1 U19 CA 148537-01 (the GAME-ON initiative). We would also like to thank the following for funding support: The Institute of Cancer Research and The Everyman Campaign, The Prostate Cancer Research Foundation, Prostate Research Campaign UK (now PCUK), The Orchid Cancer Appeal, Rosetrees Trust, The National Cancer Research Network UK, The National Cancer Research Institute (NCRI) UK. We are grateful for support of NIHR funding to the NIHR Biomedical Research Centre at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust. The Prostate Cancer Program of Cancer Council Victoria also acknowledge grant support from The National Health and Medical Research Council, Australia (126402, 209057, 251533, 396414, 450104, 504700, 504702, 504715, 623204, 940394, 614296), VicHealth, Cancer Council Victoria, The Prostate Cancer Foundation of Australia, The Whitten Foundation, PricewaterhouseCoopers, and Tattersall’s. EAO, DMK, and EMK acknowledge the Intramural Program of the National Human Genome Research Institute for their support. CS is the recipient of a doctoral fellowship from the Fonds de recherche du Québec - Santé. Additional funding and acknowledgments from individual studies in PRACTICAL are provided in supplementary materials.

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Authors and Affiliations

  1. Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, University of Quebec, 531 boul. des Prairies, Laval, QC, H7V 1B7, Canada

    Charlotte Salmon & Marie-Élise Parent

  2. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    Lixin Song

  3. School of Nursing, University of North Carolina, Chapel Hill, NC, USA

    Lixin Song

  4. Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Kenneth Muir

  5. Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK

    Kenneth Muir

  6. Department of Applied Health Research, University College London, London, WC1E 7HB, UK

    Nora Pashayan

  7. Strangeways Laboratory, Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, UK

    Nora Pashayan & Alison M. Dunning

  8. Australian Prostate Cancer Research Centre-Qld, Institute of Health and Biomedical Innovation and School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, 4059, Australia

    Jyotsna Batra

  9. Translational Research Institute, Brisbane, QLD, 4102, Australia

    Jyotsna Batra

  10. Faculty of Health Sciences, Australian Catholic University, Sydney, Australia

    Suzanne Chambers

  11. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109-1024, USA

    Janet L. Stanford

  12. Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, 98195, USA

    Janet L. Stanford

  13. National Human Genome Research Institute, National Institutes of Health, 50 South Drive, Rm. 5351, Bethesda, MD, 20892, USA

    Elaine A. Ostrander

  14. Department of Cancer Epidemiology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA

    Jong Y. Park

  15. School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA, 70112, USA

    Hui-Yi Lin

  16. Sorbonne Université, GRC n°5, AP-HP, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France

    Olivier Cussenot & Géraldine Cancel-Tassin

  17. CeRePP, Tenon Hospital, 75020, Paris, France

    Olivier Cussenot & Géraldine Cancel-Tassin

  18. Exposome and Heredity Team, CESP, UVSQ, INSERM, Gustave Roussy, Paris-Saclay University, 94805, Villejuif, France

    Florence Menegaux & Emilie Cordina-Duverger

  19. ISGlobal, Barcelona, Spain

    Manolis Kogevinas

  20. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    Manolis Kogevinas

  21. Universitat Pompeu Fabra (UPF), Barcelona, Spain

    Manolis Kogevinas

  22. CIBER Epidemiología Y Salud Pública (CIBERESP), 28029, Madrid, Spain

    Manolis Kogevinas & Javier Llorca

  23. University of Cantabria, 39005, Santander, Spain

    Javier Llorca

  24. Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical University of Sofia, Sofia, 2 Zdrave Str., 1431, Sofia, Bulgaria

    Radka Kaneva

  25. Department of Urology and Alexandrovska University Hospital, Medical University of Sofia, 1431, Sofia, Bulgaria

    Chavdar Slavov

  26. Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Azad Razack & Jasmine Lim

  27. Genomic Medicine Group, Galician Foundation of Genomic Medicine, Instituto de Investigacion Sanitaria de Santiago de Compostela (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Galego de Saúde, SERGAS, 15706, Santiago de Compostela, Spain

    Manuela Gago-Dominguez

  28. Department of Family Medicine and Public Health, Moores Cancer Center, University of California San Diego, La Jolla, CA, 92093-0012, USA

    Manuela Gago-Dominguez

  29. Genetic Oncology Unit, CHUVI Hospital, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica Galicia Sur (IISGS), 36204, Vigo (Pontevedra), Spain

    Jose Esteban Castelao

  30. The Institute of Cancer Research, London, SM2 5NG, UK

    Zsofia Kote-Jarai & Rosalind A. Eeles

  31. Royal Marsden NHS Foundation Trust, London, SW3 6JJ, UK

    Rosalind A. Eeles

  32. School of Public Health, University of Montreal, Montreal, QC, Canada

    Marie-Élise Parent

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  1. Charlotte Salmon
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UKGPCS Collaborators

APCB BioResource (Australian Prostate Cancer BioResource)

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Contributions

CS conducted the analysis and prepared the manuscript. MEP supervised the work, participated in the conception of the study, and reviewed the manuscript. All authors participated in the interpretation of data, and provided important intellectual contributions to the manuscript.

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Correspondence to Marie-Élise Parent.

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The authors declare that they have no conflict of interest.

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All individual studies were approved by local ethics committees and adhered to the principles of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study.

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Additional members from the PRACTICAL consortium are provided in the Supplementary Material. Information on the consortium can be found at http://practical.icr.ac.uk/.

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Salmon, C., Song, L., Muir, K. et al. Marital status and prostate cancer incidence: a pooled analysis of 12 case–control studies from the PRACTICAL consortium. Eur J Epidemiol 36, 913–925 (2021). https://doi.org/10.1007/s10654-021-00781-1

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