Why exactly do married/partnered prostate cancer patients live longer than single ones?

Historic data have long suggested that men with prostate cancer who are in a stable, married (or a long-term “partnered”) relationship have better long-term survival than single males. However, a poster presented by Mitteldorf at the Genitourinary Cancers Symposium in San Francisco last week (abstract no. 253; “Understanding prostate cancer survivorship relative to co-habitation”) was unable to come to any meaningful conclusions about why co-habitation status was associated with overall survival.

Mitteldorf set out to explore whether he could identify any key indicators that differed between single, married, and partnered men with prostate cancer, and which could therefore be used to explain or at least suggest an influence over the long-term survival of such men. To do this he developed a long and relatively complex online survey, and then used this survey to investigate a range of psycho-socially related issues among prostate cancer patients in a single month in 2014.

The survey asked questions about such matters as:

  • Compliance and satisfaction with patients’ treatment choices
  • Patients’ satisfaction with their lifestyle choices (including activities of life satisfaction, spirituality, and overall life sentiment)
  • Time from diagnosis until the completion of the survey
  • The size and location of the respondent’s community

In addition, every questions was stratified to account for whether or not the respondent lived alone or was married or partnered or lived in some other communal situation. The survey was then made azvailable to a randomly selected set of members of Malecare — a US -based, national prostate cancer support care network.

Here are the core study results:

  • The survey was completed by 1,762 prostate cancer patients.
  • There was no evidence from this survey of significant differences in time from diagnosis based on living status.
  • Men with prostate cancer who lived alone appeared to take strenuous exercise on more than 3 additional days per week than those who live in communal situations.
    • 20.3 percent of men who lived alone exercised for 7 days per week.
    • Only 14.2 percent of married/partnered men exercised for 7 days a week.
  • There was almost no significant correlation between answers to specific questions and whether or not a person lived alone.
    • Perhaps unsurprisingly, a sense of loneliness was the most correlated with living alone (r = 0.302).
    • Trouble urinating (r = 0.24) and trouble moving one’s bowels (r = 0.17) were also mildly correlated with being single.

Mitteldorf concludes that:

… being married, partnered or single is irrelevant to prostate cancer survivorship. Our results suggest that we have to look for reasons unrelated to personal relationships and household composition to understand why married men diagnosed with prostate cancer hold a longevity advantage over single men.

Earlier studies have not attempted or never been able to provide well-confirmed reasons for why married/partnered men with prostate cancer live longer than single ones. There is no question that this is the case, but what Mitteldorf’s study certainly seems to establish is that just “being married” or “being partnered” is not, in and of itself, the factor that determines improved survival. This raises all sorts of possible research questions about exactly why prostate cancer patients’ co-habitation status is associated with the longer-term survival of married/partnered patients.

7 Responses

  1. Readers might appreciate confirmation of the survival benefit of being married or in a stable partnered relationship for prostate cancer patents.

    One of the more recent articles to confirm this is a paper by Tyson et al. published in 2013. In this cohort of nearly 116,000 prostate cancer patents (78% of whom were married), being single was associated with a 40% increase in prostate cancer-specific mortality and a 51% increase in overall mortality. In addition, the 5-year disease-specific survival rates for married men was 89.1% compared to 80.5% for unmarried men (p < 0.0001).

  2. Conjecture, pure conjecture.

  3. (A) Possibilities of being hen-pecked and haunted to death by wife, regarding treatment?
    (B) Doubt if it’s “the great” sex life of married life?
    (C) Single males have a more realistic attitude, “When your number’s up …”?
    (D) Plain old dumb Luck?

  4. I suspect that for many married patients, there is the caring and comforting provided by the spouse/partner through ordeals of the effects of our cancer treatments and medications involved that help these men not dwell as much on these effects, whereas the single man living alone likely spends more time thinking about what he is experiencing. That of itself could cause psychological effects of worry and concern with no one providing similar caring/comforting.

  5. Was Mitteldorf’s study done in accordance with scientific standards?

  6. It is interesting to see that similar effects are seen in other cancer types, e.g., head and neck cancer.
    On the other hand, do we have any data of life expectancy of married/partnered men compared to single men in general, regardless of a cancer diagnosis?

  7. Dear Brainyblogger:

    You’d have to ask Mitteldorf that question. I have only seen the abstract and the poster, but I do know that he is a qualified medical social worker, and I have no reason to believe that the study was not done according to such standards since it would have been reviewed by the symposium planning committee prior to acceptance for presentation at the symposium.

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