Men should stop smoking 10 years BEFORE a prostate cancer diagnosis


New data from the Health Professionals Follow-Up Study (HPFUS) suggest that men who are smokers at the time of diagnosis of prostate cancer are at increased risk for prostate cancer progression or recurrence and prostate cancer-specific mortality compared to those who have never smoked or who stopped at least 10 years earlier.

Kenfield et al. used data from HPFUS to assess the impact of cigarette smoking and smoking cessation with overall, prostate cancer-specific, and cardiovascular mortality and biochemical recurrence among men with prostate cancer. HPFUS is a prospective, observational study that collected and tracked data on > 51,000 male, US-based health professionals between 1986 and 2006.

Here are the primary findings of this, particular subset analysis:

  • The study included 5,366 men diagnosed with prostate cancer between 1986 and 2006.
  • 1,630/5,366 men (30.4 percent) died during the follow-up period.
    • 524/1,630 deaths (32 percent) were due to prostate cancer.
    • 416/1,630 deaths (26 percent) were due to cardiovascular disease.
  • 878 men demonstrated a biochemical recurrence after first-line treatment for prostate cancer.
  • The absolute crude rates for prostate cancer-specific death were
    • 9.6 per 1,000 person-years for never-smokers
    • 15. per 1,000 person-years for current smokers
  • The absolute crude rates for all-cause mortality were
    • 27.3 per 1,000 person-years for never-smokers
    • 53.0 per 1,000 person-years for current smokers
  • Compared to never-smokers
    • Current smokers had an increased risk of prostate cancer-specific mortality (hazard ratio [HR] = 1.61).
    • Current smokers with clinical stage T1 through T3 had an increased risk of prostate cancer-specific mortality (HR = 1.80).
    • Current smokers had an increased risk of biochemical recurrence (HR = 1.61).
    • Current smokers had an increased risk of total mortality (HR = 2.28).
    • Current smokers had an increased risk of cardiovascular mortality (HR = 2.13).

After making adjustments for clinical stage and grade, which the authors considered to be “likely intermediates of the relation of smoking with prostate cancer recurrence and survival,” the study data also showed that:

  • Again compared to never-smokers
    • Current smokers had an increased risk of prostate cancer-specific mortality (HR = 1.38).
    • Current smokers with clinical stage T1 through T3 had an increased risk of prostate cancer-specific mortality (HR = 1.41).
    • Current smokers had an increased risk of biochemical recurrence (HR, 1.4

Finally, if men smoked more or had stopped smoking, it also impacted risk:

  • Compared to never-smokers
    • Current smokers of ≥ 40 pack-years had an increased risk of prostate cancer-specific mortality (HR = 1.82)
    •  Current smokers of ≥ 40 pack-years had an increased risk of biochemical recurrence (HR = 1.48)
  • Compared to current smokers
    • Men who had stopped smoking for 10 or more years had a prostate cancer-specific mortality risk similar to that of never-smokers (HR = 0.60 vs. 0.61).
    • Men who had stopped smoking for < 10 years but smoked < 20 pack-years had a prostate cancer-specific mortality risk similar to never smokers (HR = 0.64 vs. 0.61).

Kenfield and her colleagues conclude that — among men followed for up to 20 years — smoking at the time of prostate cancer diagnosis is associated with

  • An increase in overall mortality
  • An increase in cardiovascular mortality
  • An increase in prostate cancer–specific mortality
  • An increase in prostate cancer recurrence.

However, they also note that men who have quit for at least 10 years have a similar level of risk for prostate cancer–specific mortality as those men who have never smoked at all.

If there is one clear implication of this study, it is that — quite apart from all the other reasons why smoking is a bad idea — for men who are at increased risk of prostate cancer for any of the normal reasons (familial risk, ethnicity, etc.), smoking is only going to add to the long-term risk that prosttae cancer will be a potential cause of death.

One Response

  1. In general smoking increases the possibility of cancer. It’s important for those who are smoking and who want to quit to really realize this and try to use it as motivation to stop smoking permanently.

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