Abstract
Objective. To evaluate the relationship between educational level and prostate cancer (PC) survival and explore the role of histological differentiation and reasons for PC testing on this association. Materials and methods. A retrospective cohort was constructed by linking data from men diagnosed with PC between 2011 and 2014 in two secondary care and four tertiary-care hospitals in Mexico City with the National Death Registry, with follow-up through December 2021. Educational level, reasons for testing (symptomatic vs preventive), and histological differentiation were obtained through structured questionnaires. Overall survival (OS) and PC-specific survival (PCSS) at five and eight years were estimated using Kaplan-Meier curves, and PC mortality was evaluated using Cox proportional hazards models. Results. During a median follow-up of 8.34 years, OS was 81%, and PCSS was 85%. Lower educational level was associated with higher PC mortality (adjusted HR 2.30; 95%CI: 1.16,4.54). The highest mortality was observed among men with low education and poorly differentiated tumors or among those who underwent screening due to the presence of prostate symptoms. Conclusions. Educational level was the strongest predictor of PC survival, underscoring the importance of targeted health education to improve preventive care, informed decision-making, and treatment adherence.