Men who smoke at the time of radical prostatectomy or radiation therapy for localized prostate cancer (PCa) have higher risks for biochemical recurrence, metastasis, and cancer-specific mortality than nonsmokers, a new study finds.

Shahrokh F. Shariat, MD, of Medical University of Vienna in Austria and colleagues conducted a systematic review of observational studies published 2000 to March 2017 including 22,549 patients. Sixteen papers were reviewed for qualitative analysis and 11 papers for quantitative analysis. Nearly one in 5 men (18.6%) smoked at the time of primary treatment.

Over 72 months, current smokers had significantly higher risks for biochemical recurrence (40%), metastasis (251%), and cancer-specific mortality (89%) than nonsmokers, according to results published in JAMA Oncology. Former smokers had a 19% greater risk for biochemical recurrence, but their elevated risks for metastasis and cancer-specific mortality were nonsignificant.

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The connection between smoking and PCa is biologically plausible, according to the investigators. They suggested inflammatory pathways within the prostate, increasing interleukin 8 levels from nicotine exposure, or multigene hypermethylation.

According to Stephen J. Freedland, MD, of Cedars-Sinai in Los Angeles, who wrote an accompanying editorial, the finding of increased death risk among smokers “…argues that the higher rate of death from prostate cancer among smokers is “real”; that is, there is a biological cause.”

“These results should encourage radiation oncologists and urologists to counsel patients on smoking cessation, given the risk of poorer oncologic outcomes associated with smoking,” Dr Shariat and the team stated. Consultation for local therapy represents “a teachable moment.”


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: A Systematic Review and Meta-analysis. JAMA Oncol. DOI:10.1001/jamaoncol.2018.1071. [Published online May 24, 2018]

Freedland SJ. Smoking and Death From Prostate Cancer. JAMA Oncol. [Published online May 24, 2018]