Smoking and Risk of Prostate Cancer and Prostate Cancer Death: A Pooled Study

Jochems, Sylvia H J; Fritz, Josef; Häggström, Christel; Järvholm, Bengt; Stattin, Pär; Stocks, Tanja

doi:10.1016/j.eururo.2022.03.033

Cited by 27 publications

(21 citation statements)

References 45 publications

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“…[28][29][30] This parallels what is observed in smokers: a lower incidence of disease but worse disease on discovery. 8,12,16 Our results contribute evidence towards this hypothesis and provide a critically important picture of the value of PSA screening as a preventive measure to reduce the burden of PCa. The exact mechanisms behind the differences in PSA screening related to smoking are unclear.…”

Section: Discussionsupporting

confidence: 55%

Prostate-Specific Antigen Screening in Smokers: A Comprehensive Analysis Using a National Behavioral Survey

Harmatz,

Alkhatib,

Leff

et al. 2024

Urology Practice

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Introduction: Cigarette smoking is associated with higher-risk prostate cancer at the time of diagnosis and increased overall and prostate cancer-specific mortality. Previous studies indicate smokers are less likely to undergo PSA screening. Herein we investigate the association between smoking and PSA screening using a nationally representative US survey. We hypothesize that smokers are less likely to undergo guideline-concordant PSA screening.Methods: We performed a cross-sectional analysis of men aged 55 to 69 who responded to the cigarette smoking and PSA screening questions of the 2018 Behavioral Risk Factor Surveillance System survey. Adjusted prevalence and adjusted risk differences were calculated using complex weighted multivariable Poisson regression modeling.Results: We identified 58,996 individuals who qualified for analysis. PSA screening prevalence was 39% (95% CI: 39%-40%) nationally, 42% (95% CI: 41%-44%) for never smokers, 42% (95% CI: 39%-40%) for former smokers, and 27% (95% CI: 25%-29%) for current smokers, including 27% (95% CI: 24%-29%) for daily smokers and 29% (95% CI: 24%-33%) for nondaily smokers. Compared to never smokers, the adjusted relative risk for undergoing PSA screening was 0.81 for current smokers (95% CI: 0.75-0.88, P < .01) and 0.99 for former smokers (95% CI: 0.94-1.03, P ¼ .53).

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Section: Discussionsupporting

confidence: 55%

Prostate-Specific Antigen Screening in Smokers: A Comprehensive Analysis Using a National Behavioral Survey

Harmatz,

Alkhatib,

Leff

et al. 2024

Urology Practice

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“…We also collected from the BRFSS survey data the demographic characteristics of age, sex, race and ethnicity (Hispanic, Non-Hispanic Asian [hereafter Asian], Non-Hispanic Black [hereafter Black], Non-Hispanic American Indian [hereafter American Indian], or Non-Hispanic White [hereafter White]), marital status (never married; married; divorced, widowed, or separated; or unmarried partnership), annual income (<$25 000, $25 000-$50 000, >$50 000-$74 000, >$75 000), educational level (no high school diploma or attendance, high school diploma or GED [General Educational Development] certificate, some college, or college degree), employment status (employed, unemployed, homemaker, student, or retired), and smoking status (never smoker, every day, or some days); prostate cancer diagnosis history; and access-to-care information, including whether respondents had a primary care physician (PCP; yes or no) and any cost barrier to care (yes or no). The associations of these variables with recent PSA screening within the study cohort were specifically assessed, as these variables have been reported as factors in PSA screening use in target populations …”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The associations of these variables with recent PSA screening within the study cohort were specifically assessed, as these variables have been reported as factors in PSA screening use in target populations. [10][11][12][13][14][15][16][17][18] Based on their responses regarding receipt of a PSA test and time elapsed since their last PSA test, the male respondents were grouped into mutually exclusive, time-based PSA screening categories: never, past year, past 2 years, past 3 years, past 5 years, or more than 5 years. Given the national PSA screening guidelines, respondents were considered to be recently screened if they had a PSA test within the past 2 years.…”

Section: Jama Network Open | Oncologymentioning

confidence: 99%

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Low-Value Prostate-Specific Antigen Screening in Older Males

et al. 2023

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ImportanceThe US Preventive Services Task Force guidelines advise against prostate-specific antigen (PSA) screening for prostate cancer in males older than 69 years due to the risk of false-positive results and overdiagnosis of indolent disease. However, this low-value PSA screening in males aged 70 years or older remains common.ObjectiveTo characterize the factors associated with low-value PSA screening in males 70 years or older.Design, Setting, and ParticipantsThis survey study used data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS), a nationwide annual survey conducted by the Centers for Disease Control and Prevention that collects information via telephone from more than 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. The final cohort comprised male respondents to the 2020 BRFSS survey who were categorized into the following age groups: 70 to 74 years, 75 to 79 years, or 80 years or older. Males with a former or current prostate cancer diagnosis were excluded.Main Outcomes and MeasuresThe outcomes were recent PSA screening rates and factors associated with low-value PSA screening. Recent screening was defined as PSA testing within the past 2 years. Weighted multivariable logistic regressions and 2-sided significance tests were used to characterize factors associated with recent screening.ResultsThe cohort included 32 306 males. Most of these males (87.6%) were White individuals, whereas 1.1% were American Indian, 1.2% were Asian, 4.3% were Black, and 3.4% were Hispanic individuals. Within this cohort, 42.8% of respondents were aged 70 to 74 years, 28.4% were aged 75 to 79 years, and 28.9% were 80 years or older. The recent PSA screening rates were 55.3% for males in the 70-to-74-year age group, 52.1% in the 75-to-79-year age group, and 39.4% in the 80-year-or-older group. Among all racial groups, non-Hispanic White males had the highest screening rate (50.7%), and non-Hispanic American Indian males had the lowest screening rate (32.0%). Screening increased with higher educational level and annual income. Married respondents were screened more than unmarried males. In a multivariable regression model, discussing PSA testing advantages with a clinician (odds ratio [OR], 9.09; 95% CI, 7.60-11.40; P &lt; .001) was associated with increased recent screening, whereas discussing PSA testing disadvantages had no association with screening (OR, 0.95; 95% CI, 0.77-1.17; P = .60). Other factors associated with a higher screening rate included having a primary care physician, a post–high school educational level, and income of more than $25 000 per year.Conclusions and RelevanceResults of this survey study suggest that older male respondents to the 2020 BRFSS survey were overscreened for prostate cancer despite the age cutoff for PSA screening recommended in national guidelines. Discussing the benefits of PSA testing with a clinician was associated with increased screening, underscoring the potential of clinician-level interventions to reduce overscreening in older males.

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“…17 Second, best evidence suggests that psychosocial stress does not directly cause cancer, and although it can lead to behaviors, such as smoking and drinking, that raise cancer risk, 18,19 prostate cancer is not importantly influenced by these exposures. 20,21 Moreover, unlike cervical or colon cancer, prostate cancer is not preventable if caught at a premalignant state and hence limited access to medical care cannot affect prostate cancer risk.…”

Section: Race and Prostate Cancer Incidencementioning

confidence: 99%