Smoking as a Risk Factor for Prostate Cancer: A Meta-Analysis of 24 Prospective Cohort Studies

Huncharek, Michael; Haddock, Kathlyn Sue; Reid, Rodney; Kupelnick, Bruce

doi:10.2105/ajph.2008.150508

Cited by 252 publications

(226 citation statements)

References 34 publications

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“…This result is supported by a more recent meta-analysis of 24 cohorts, which showed that smoking increased the risk of fatal prostate cancer. 5 The adverse effects of smoking on advanced or fatal prostate cancer may reflect its effect on tumor progression. For example, smoking may increase serum estrogen metabolites, which have been postulated to induce a more aggressive tumor and thereby increase prostate cancer death.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11] However, one report showed that smoking of 35 or more cigarettes per day increased the risk of prostate cancer mortality, 12 while a meta-analysis also showed that current smokers had an increased risk of fatal prostate cancer. 5 These findings suggest that the effects of smoking might differ according to stage. Moreover, the lower rates of PSA screening among smokers than nonsmokers might lead to attenuation of a positive association, as it does in alcohol drinkers.…”

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confidence: 96%

“…4 A recent meta-analysis of 24 prospective cohort studies showed no increased risk of incident prostate cancer for current smokers, but a statistically significant increase in risk for amount and pack-years of smoking. 5 Epidemiological research suggests that the results of studies examining incidence may differ from those studying prostate cancer mortality. 6 Interestingly, five studies found no positive association between smoking and prostate cancer incidence in Japan, albeit that analysis was not done according to stage.…”

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confidence: 99%

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Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: The Japan Public Health Center‐based prospective study

Sawada¹,

Inoue

Iwasaki³

et al. 2013

Intl Journal of Cancer

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Although alcohol and smoking have not been established as risk factors for prostate cancer, they are important risk factors for other human cancers and potentially major avoidable factors. Alcohol drinkers and smokers might be less likely to get screening, which might lead to attenuation of the positive association. Here, we investigated the association of alcohol drinking and smoking and prostate cancer according to stage, as well as prostate cancer detected by subjective symptoms, in a large prospective study among Japanese men. The Japan Public Health Center-based prospective study (JPHC study) was established in 1990 for Cohort I and in 1993 for Cohort II. Subjects were 48,218 men aged 40-69 years who completed a questionnaire, which included their alcohol and smoking habits at baseline, and who were followed until the end of 2010. During 16 years of follow-up, 913 men were newly diagnosed with prostate cancer; of whom 248 had advanced cases, 635 were organlocalized and 30 were of an undetermined stage. Alcohol consumption was dose-dependently associated with advanced prostate cancer [nondrinkers: reference, 0-150 g=week: hazard ratio (HR) 5 1.23, 95% confidence interval (CI) 5 0.83-1.82; 150-300 g=week: HR 5 1.51, 95% CI 5 1.04-2.19; 300 g=week: HR 5 1.41, 95% CI 5 0.97-2.05, p for trend 5 0.02]. The positive association was not substantially changed among cancers detected by subjective symptoms. Smoking was inversely associated with prostate cancer among total subjects, but tended to increase the risk of advanced prostate cancer detected by subjective symptoms. In conclusion, abstinence from alcohol and prohibition of smoking might be important factors in the prevention of advanced prostate cancer.Alcohol and smoking are important risk factors for human cancers and potentially major avoidable factors. The report by the World Cancer Research Fund=American Institute for Cancer Research (WCRF=AICR) on nutrition, physical activity and cancer concluded that the data were too limited to determine an association between alcohol and prostate cancer. 1 Further, a recent meta-analysis of 50 case-control and 22 cohort studies concluded that there was no evidence of a material association between alcohol drinking and prostate cancer. 2 However, questions remain about the effects of alcohol use at higher intake. Given that the proportion of heavy drinkers has been increasing for decades in Japan, 3 research in Japan might help answer these unsolved questions. Moreover, the effects of alcohol in different histological grades of prostate cancer are also controversial. It is possible that previous studies were affected by detection bias associated with screening, such as prostate-specific antigen (PSA) screening, which would mask an association if alcohol drinkers were less likely to get screening.With regard to tobacco, the International Agency for Research on Cancer does not consider prostate cancer to be tobacco-related. 4 A recent meta-analysis of 24 prospective cohort studies showed no increased risk of incident pros...

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Section: Discussionmentioning

confidence: 99%

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confidence: 96%

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confidence: 99%

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Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: The Japan Public Health Center‐based prospective study

Sawada¹,

Inoue

Iwasaki³

et al. 2013

Intl Journal of Cancer

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“…26 A metaanalysis of 24 cohort studies also suggested that current smokers were not at increased risk for incident prostate cancer. 27 These findings may be partially attributable to detection bias resulting from the inverse relationship between smoking and PSA. If smoking substantially alters the relationship between PSA and any potential underlying prostate cancer, we may need to modify, according to smoking status, the often used PSA cutoff points that signal the necessity of further evaluation with prostate biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Thompson

Joseph

et al. 2012

Journal of Urology

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Purpose-There are scant data available on the relationship between smoking and total prostate specific antigen, free prostate specific antigen and percent-free prostate specific antigen. Given the high prevalence of smoking and the frequency of prostate specific antigen screening, it is important to determine any association between smoking and prostate specific antigen values using nationally representative data.Materials and Methods-Included in the final study population were 3,820 men 40 years old or older who participated in the 2001-2006 NHANES (National Health and Nutrition Examination Survey) and met the eligibility criteria for prostate specific antigen testing. The distributions of total, free and percent free prostate specific antigen were estimated by sociodemographic and clinical characteristics. Multivariate linear regression models were fit to determine the adjusted relationship between smoking and total and percent free prostate specific antigen while simultaneously controlling for these characteristics.Results-For all ages combined the median total and free prostate specific antigen levels were 0.90 (0.81-0.90) and 0.26 (0.25-0.28) ng/ml, respectively. Multivariate linear regression analysis showed that total prostate specific antigen was 7.9% and 12.2% lower among current and former smokers, respectively, than among never smokers. High body mass index and diabetes were also statistically significantly associated with a lower total prostate specific antigen. Approximately a third of the men had a percent free prostate specific antigen less than 25%. Current smokers had a significantly lower percent free prostate specific antigen than former smokers.Conclusions-Our finding that smoking is inversely associated with total prostate specific antigen may have potential implications for the interpretation of prostate specific antigen levels in men who are current or former smokers. Given the high prevalence of smoking, obesity and diabetes, additional research on the combined effect of these health risk factors is warranted. Keywords HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAlthough the mortality benefit from screening with PSA is uncertain, 1,2 PSA based screening has resulted in a downward stage shift to more organ confined prostate cancer at the time of diagnosis. 3 The often used PSA cut point of greater than 4.0 ng/ml detects the majority of prostate cancers. However, the specificity of the PSA test is low and has led to a high rate of false-positive results, particularly among older men with BPH. Percent-free PSA (the ratio of fPSA-to-tPSA) testing has been used as an adjunct to PSA tests to enhance the specificity and decrease the number of unnecessary biopsies. 4 It has been recognized that age, race, BPH, prostate size and prostatitis can influence PSA levels. 5,6 Epidemiological studies have also shown that PSA can be affected by several heath characteristics including obesity, diabetes and certain medications such as NSAIDs, statins and...

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Association of Smoking Status With Recurrence, Metastasis, and Mortality Among Patients With Localized Prostate Cancer Undergoing Prostatectomy or Radiotherapy

et al. 2018

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Smoking as a Risk Factor for Prostate Cancer: A Meta-Analysis of 24 Prospective Cohort Studies

Abstract: Observational cohort studies show an association of smoking with prostate cancer incidence and mortality. Ill-defined exposure categories in many cohort studies suggest that pooled data underestimate risk.

Cited by 252 publications

References 34 publications

Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: The Japan Public Health Center‐based prospective study

Alcohol and smoking and subsequent risk of prostate cancer in Japanese men: The Japan Public Health Center‐based prospective study

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

Association of Smoking Status With Recurrence, Metastasis, and Mortality Among Patients With Localized Prostate Cancer Undergoing Prostatectomy or Radiotherapy

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