Smoking and Prostate Cancer Survival and Recurrence

Abstract

Context Studies of smoking in relation to prostate cancer mortality or recurrence in prostate cancer patients are limited, with few prostate cancer-specific outcomes. Objective To assess the relation of cigarette smoking and smoking cessation with overall, prostate cancer-specific, and CVD mortality and biochemical recurrence among men with prostate cancer. Design, Setting, and Participants Prospective observational study of 5 366 men diagnosed with prostate cancer between 1986–2006 in the Health Professionals Follow-Up Study. Main Outcome Measures Hazard ratios (HRs) for overall, prostate cancer-specific, and CVD mortality, and biochemical recurrence, defined by PSA rise. Results We documented 1,630 deaths, 524 (32%) due to prostate cancer and 416 (26%) due to CVD, and 878 biochemical recurrences. The absolute crude rates for prostate cancer-specific death for never smokers vs. current smokers were 9.6 vs. 15.3 per 1,000 person-years; for all-cause mortality the corresponding rates were 27.3 and 53.0 per 1,000 person-years. In multivariable analysis, compared with never smokers, current smokers had an increased risk of prostate cancer mortality (HR, 1.61; 95% confidence interval [CI], 1.11–2.32 and among men with clinical stage T1–T3: HR, 1.80; 95% CI, 1.04–3.12), biochemical recurrence (HR, 1.61; 95% CI, 1.16–2.22), total mortality (HR, 2.28; 95% CI, 1.87–2.80), and CVD mortality (HR, 2.13; 95% CI, 1.39–3.26). After adjusting for clinical stage and grade which are likely intermediates of the relation of smoking with prostate cancer recurrence and survival, the estimates for current smoking were as follows: prostate cancer mortality (HR, 1.38; 95% CI, 0.94–2.03 and HR, 1.41; 95% CI, 0.80–2.49); biochemical recurrence (HR, 1.47; 95% CI, 1.06–2.04). A greater number of pack-years was associated with a significantly increased risk of prostate cancer mortality but not biochemical recurrence: for current smokers of 40+ pack-years compared to never smokers: prostate cancer mortality (HR, 1.82; 95% CI, 1.03–3.20; biochemical recurrence (HR, 1.48; 95% CI, 0.88–2.48). Compared to current smokers, those who had quit smoking for 10 or more years, or who had quit for less than 10 years but smoked less than 20 pack-years, had prostate cancer mortality risks similar to never smokers: former smoker, quit 10+ years (HR, 0.60; 95% CI, 0.42–0.87); quit <10 years and <20 pack-years (HR, 0.64; 95% CI, 0.28–1.45); never smoker (HR, 0.61; 95% CI, 0.42–0.88). Conclusions Smoking at the time of prostate cancer diagnosis is associated with increased overall and CVD mortality and prostate cancer-specific mortality and recurrence. 10-year quitters have prostate cancer-specific mortality risks similar to never smokers.

Cigarette smoking during external beam radiation therapy for prostate cancer is associated with an increased risk of prostate cancer‐specific mortality and treatment‐related toxicity

“…Many studies have shown a significant and consistent association between smoking and increased mortality from prostate cancer [1][2][3][4][5][6]. These studies differed in how they defined smokers and their risk after ceasing to smoke.…”

“…While incident studies have been inconsistent, mortality studies have consistently shown a significant correlation between cigarette smoking and increased mortality from prostate cancer [1][2][3][4][5][6][7]. Given the prevalence of smoking in the USA (the Centers for Disease Control and Prevention reported that, as of 2010, 19.3% of USA adults were current smokers) and the prevalence of prostate cancer, there is a need to determine if smoking negatively influences the success of local therapy.…”

Association Between Smoking Status, and Free, Total and Percent Free Prostate Specific Antigen

“…However, studies have consistently shown that current smokers have an increased risk of fatal prostate cancer. 27,29 Delayed detection of prostate cancer due to the effects of smoking on PSA may contribute in part to worse health outcomes of prostate cancer among smokers.…”

Risk-Based Prostate Cancer Screening: Who and How?

“…Men who perform moderate amounts of exercise weekly have been shown to have lower risk of prostate cancer diagnosis, as well as risk of high-grade disease [37]. Additionally, tobacco smoking at the time of prostate cancer diagnosis is associated with increased prostate-cancer-specific mortality, as well as biochemical recurrence, after adjusting for stage, grade, and PSA screening history [38]. Men with male factor infertility have been found to have increased risk of prostate cancer [39].…”