Smoking detriment to long-term prostate cancer outcomes

A US study indicates that men with prostate cancer who smoke at the time of undergoing radical prostatectomy have more aggressive cancers at baseline and poorer long-term outcomes than nonsmokers.

“If confirmed in other studies, this would establish smoking as a modifiable risk factor among patients with aggressive [prostate cancer],” say authors Daniel Moreira (North Shore Long Island Jewish Health System, New York, USA) and colleagues.

They studied 549 men with prostate cancer who were active smokers and 951 men who were nonsmokers at the time of radical prostatectomy, and followed up for a median of 61 to 78 months for different outcomes.

Patients who smoked already had poorer disease characteristics at the time of surgery than those who did not. For example, they had significantly higher preoperative prostate-specific antigen (PSA) levels, and a higher incidence of extracapsular extension and seminal vesicle invasion than nonsmokers. There was also a nonsignificant trend toward higher Gleason scores and positive surgical margins among smokers.

The team found that smoking was independently associated with a 2.4-fold increased risk for metastasis in a competing risk analysis that accounted for both preoperative and postoperative characteristics. Similarly, it led to a 2.6-fold increased risk for castration-resistant prostate cancer, and a 2.0-fold increased risk for all-cause mortality during follow-up.

Additionally, a greater proportion of smokers than nonsmokers experienced biochemical disease recurrence during follow-up; however, this was not significant after adjustment for preoperative and postoperative characteristics.

Writing in Cancer, Moreira and team explain that the role of smoking in prostate cancer incidence and prognosis has so far remained unclear, with studies providing conflicting results on its influence on biochemical recurrence, castration-resistant disease, and progression.

They say that their study, which is the first to examine long-term outcomes in prostate cancer patients who smoke, indicates that smoking is a modifiable risk factor in aggressive prostate cancer. However, they conclude that “[w]hether smoking cessation after diagnosis can limit the adverse effects of smoking requires further study.”

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