Smoking During Primary Therapy Worsens Oncologic Outcomes in Prostate Cancer

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The impact of smoking on prostate cancer incidence and outcomes is still debated.
The impact of smoking on prostate cancer incidence and outcomes is still debated.

Rates of biochemical recurrence, metastasis, and cancer-specific mortality are higher among patients who smoke throughout curative treatment for prostate cancer, according to a study published in JAMA Oncology

Smoking tobacco is a known, preventable risk factor for many genitourinary cancers such as bladder, upper tract urothelial, and renal cell carcinoma, but how it may modify incidence and outcomes for prostate cancer — although fairly well-documented — is still under debate. For this study, researchers sought to determine the impact of smoking during primary treatment of prostate cancer

For this meta-analysis and systematic review, researchers analyzed the findings of 11 studies published between January 2000 and March 2017 that were representative of 22,549 patients. Eligible patients were undergoing radiotherapy (RT) or radical prostatectomy (RP) for localized prostate cancer. Selected studies were nonrandomized, observational, and had a median follow-up of 72 months. 

Of all included patients, 4202 (18.6%) actively smoked while undergoing primary RT or RP. 

Results showed that the risk of biochemical recurrence was significantly elevated among both current (<.001) and former (P<.001) smokers compared with never smokers. 

Current smokers also had significantly increased risk of metastasis (P<.001) and cancer-specific mortality (P<.001) compared with former smokers and never smokers. Former smokers did not have significant elevations in the risk of cancer-specific mortality or metastasis. 

The authors concluded that “our findings encourage radiation oncologists and urologists to counsel patients to stop smoking, using primary prostate cancer treatment as a teachable moment. Further studies with clear definitions of the study population and a precise assessment of the smoking exposure are needed to clarify the association of smoking cessation with long-term oncologic outcomes.”


Foerster B, Pozo C, Abufaraj M, et al. Association of smoking status with recurrence, metastasis, and mortality among patients with localized prostate cancer undergoing prostatectomy or radiotherapy[published online May 24, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.1071

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