Prostate cancer is the fifth most commonly diagnosed cancer and the seventh leading cause of cancer mortality in Asia. Lower education level is associated with less cancer screening, more advanced cancer at diagnosis and poorer treatment outcomes. In this study, we aim to investigate the association between education level and primary treatment modalities amongst Asian prostate cancer patients.

We conducted a cross-sectional study involving prostate cancer patients diagnosed with prostate cancer between 2016 and 2018 under the Asian Prostate Cancer (A-CaP) Study Group. The A-CaP Study Group consists of 12 Asian countries including Korea, Hong Kong, Japan, Taiwan, Philippines, Malaysia, Turkey, Vietnam, Thailand, Indonesia, Jordan and Singapore. Clinical parameters, education level and primary treatment modalities were extracted from patient records and evaluated using multivariable logistic regression analyses.

A total of 7917 of prostate cancer patients were included into the study. In localised disease, patients undergoing radiotherapy was significantly associated with education level (adjusted odds ratio [aOR] for secondary and tertiary education = 1.78, 95% confidence interval [CI] 1.36-2.33, and aOR 1.41, 95% CI 1.06 – 1.87), respectively compared to primary education), older age (aOR for 65-69 years, 70-74 years and > 74 years = 1.60, 95% CI 1.19 – 2.16, aOR 2.66, 95% CI 1.98 – 3.57 and aOR 2.62, 95% CI 1.96 – 3.51, respectively) and intermediate (aOR 2.08, 95% CI 1.56 – 2.79) to high D’Amico risk group (aOR 1.54, 95% CI 1.15 – 2.07). Men with secondary (aOR 3.19, 95% CI 1.70 – 5.99) and tertiary (aOR 2.40, 95% CI 1.24 – 4.65) education level were more likely to be treated with primary androgen deprivation therapy than men with primary education in locally-advanced cases. The odds of radical prostatectomy increased with tertiary education level, younger age (< 65 years old) and absence of metastases (M0) (p < 0.01) in stage IV patients.

Education level, age at diagnosis and disease characteristics were independently associated with choice of primary treatment in Asian prostate cancer patients.