Open Access Open Badges Research article

High incidence of prostate cancer metastasis in Afro-Brazilian men with low educational levels: a retrospective observational study

Alexandre Barbosa Câmara de Souza1, Hugo Gonçalo Guedes1, Victor Carbone Bernardes Oliveira1, Fábio Aires de Araújo1, Carlos Cesar Oliveira Ramos2, Karina Carla Paula Medeiros1 and Raimundo Fernandes Araújo1*

Author affiliations

1 Department of Morphology, Federal University of Rio Grande do Norte, Natal 59072-970, Rio Grande do Norte, Brazil

2 Doctor Luiz Antonio Hospital, Natal 59040-000, Rio Grande do Norte, Brazil

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Citation and License

BMC Public Health 2013, 13:537  doi:10.1186/1471-2458-13-537

Published: 4 June 2013



This study investigated factors related to ethnicity and educational level, their correlation with tumor stage at the time of diagnosis, and their influence on treatment outcomes in patients with prostate cancer.


In this retrospective observational study, we analyzed the medical records of 1,349 male patients treated for prostatic adenocarcinoma. We collected information about sociodemographic variables, including educational level and self-reported skin color. We also classified the disease according whether it was to more likely to present with metastasis and measured the tumor response to treatment.


Less-educated (<8 years of education) individuals were 4.8 times more likely to develop metastasis than those with more education (>11 years of education; p < 0.001). Similarly, patients with a self-reported black skin color had a 300% increased risk of metastasis at diagnosis (p = 0.001). Distant metastasis was independently correlated with worse outcomes, such that individuals with distant metastasis were 10 times more likely to die than were those without distant metastasis.


Patients with self-reported black skin color and <8 years of education were more likely to display advanced disease at the time of diagnosis compared with their counterparts. Only the presence of metastasis was independently associated with mortality or progressive disease.

Epidemiology; Prognosis; Prostate cancer; Risk factor; Educational levels