Smoking and aggressive prostate cancer: a review of the epidemiologic evidence

Abstract

Although tobacco use has been recognized as one of the leading causes of cancer morbidity and mortality, a role of smoking in the occurrence of prostate cancer has not been established. However, evidence indicates that factors that influence the incidence of prostate cancer may differ from those that influence progression and fatality from the disease. Thus, we reviewed and summarized results from prospective cohort studies that assessed the relation between smoking and fatal prostate cancer risk, as well as epidemiological and clinical studies that focused on aggressive behavior in prostate cancer, such as poorer survival, advanced stage, or poorer differentiation at diagnosis. The majority of the prospective cohort studies showed that current smoking is associated with a moderate increase of ~30% in fatal prostate cancer risk compared to never/non-smokers. This association is likely to be an underestimate of the effect of smoking because most studies had a single assessment of smoking at baseline and long follow-up times, and the association was considerably stronger in some sub-groups of heaviest smokers, or when smoking was assessed in a relatively short period (within 10 years) prior to cancer mortality. Using aggressive behavior of prostate cancer as outcome, current smoking was associated with significantly elevated risk, ranging from around twofold to threefold or higher. Although alternative explanations, such as publication bias, residual confounding, screening bias, and the influence of smoking-related comorbidities cannot be ruled out entirely, these findings suggest that smoking is associated with aggressive behavior of prostate cancers or with a sub-group of rapidly progressing prostate cancer. Based on evidence presented in this review, cigarette smoking is likely to be a risk factor for prostate cancer progression and should be considered as a relevant exposure in prostate cancer research and prevention of mortality from this cancer.

Epidemiology of Prostate Cancer

“…Smokers have 14% more risk of dying from prostate cancer as compared to nonsmokers (Huncharek et al, 2010). Smoking may stimulate the development of more aggressive, hormone-sensitive cancers through several mechanisms, comprising effects on sex steroid hormone levels and continuous exposure to carcinogens for example polycyclic aromatic hydrocarbons contained in cigarette smoke (Zu and Giovannucci, 2009).…”

Tobacco or Health? Harmful Effects of Tobacco on the Human Body

“…Hormonlar ve büyüme faktörleri kanserin gelişiminde rol oynar. 2009 yılında Zu ve arkadaşları tütün içimi ile alınan bileşiklerin DNA metilasyonu, anjiogenesis, seks hormonları düzeyini etkileyerek kanser progresyonu ve mortalite üzerine etkili olduğunu gösterdiler (17) . Sigara içiminin prostat kanseri gelişimine neden olduğuna dair çelişkili çalışmalar vardır (7) .…”

Evaluation of the impact of various definitions of rurality on the prediction of prostate cancer progression

“…Risk factors that influence the development of prostate cancer, however, may differ from those that influence progression and survival (Zu & Giovannucci, 2009). Given that more men are being diagnosed at early stage disease, leading to increased survival and improved quality of life, prostate cancer progression and associated predictors are now receiving much attention (Buhmeida, Pyrhönen, Laato, & Collan, 2006).…”

“…Predictors of prostate cancer progression include: Gleason score, tumour stage, positive surgical margins at diagnosis, and tumour volume Ploussard et al, 2011). In addition, the roles of age, genetic factors, diet, smoking, fluctuations in hormone levels (including testosterone, leptin, and adiponectin), metabolic syndrome components (including obesity, hypercholesterolaemia, diabetes, and hyperinsulinaemia), prostate volume, the percent and number of positive biopsies cores and the maximal involvement of a single core at initial diagnosis, the initial PSA (prostate specific antigen), PSA density, PSA velocity, percent free-tototal PSA, PSA doubling time, and rapid PSA doubling time (i.e., less than six months doubling time), worst Gleason scores (i.e., Gleason score of 6 or less versus higher and Gleason score of 7 or less versus higher), and more have been associated with prostate cancer progression (Boorjian, Tollefson, Thompson, et al, 2012;Ploussard et al, 2011;Rhee, Vela, & Chung, 2016;Tolonen et al, 2011;Venkitaraman et al, 2007;Zu & Giovannucci, 2009).…”