Abstract
Purpose
Tobacco smoking has been found to increase prostate cancer (PCa) mortality in cohorts of healthy men, but its effects on prognosis of men with PCa are still unclear. This study investigated the role of smoking on long-term survival after PCa diagnosis.
Methods
A retrospective cohort including 780 men with incident PCa previously enrolled (between 1995 and 2002) as cases in an Italian case–control study. Information on vital status up to 2013 (median follow-up 13 years) and cause of death were retrieved through health archives. Hazard ratios (HRs) of all-cause and PCa-specific death, and corresponding 95 % confidence intervals (CIs), were calculated using Cox models, adjusting for Gleason score and major confounders.
Results
Out of 263 PCa deceased patients, 81 died because of PCa. Smokers at PCa diagnosis reported increased risks of all-cause (HR = 1.5, 95 % CI 1.1–2.2) and PCa death (HR = 2.0, 95 % CI 1.0–3.8), as compared to never smokers. Dose–response effects emerged according to smoking intensity (HRs for >15 cigarettes/day: 1.9, 95 % CI 1.3–3.0, for all causes and 2.3, 95 % CI 1.1–4.9, for PCa) and duration (HRs for >45 years: 1.7, 95 % CI 1.1–2.6, for all causes and 2.6, 95 % CI 1.2–5.5, for PCa). Conversely, former smokers at PCa diagnosis showed no statistically significant higher risks of PCa death. The effects of smoking were consistent in strata of Gleason score.
Conclusions
Current smoking at PCa diagnosis negatively impacted PCa-specific, long-term survival, regardless of Gleason score. Our findings suggest that smoking could be a modifiable risk factor to improve prognosis of men diagnosed with PCa.
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References
Etzioni R, Tsodikov A, Mariotto A, Szabo A, Falcon S, Wegelin J, Di Tommaso D, Karnofski K, Gulati R, Penson DF, Feuer E (2008) Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control 19:175–181
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2013) GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11. IARC: Lyon, France. http://globocan.iarc.fr. Accessed 16 Feb 2015
Verdecchia A, Guzzinati S, Francisci S, De Angelis R, Bray F, Allemani C, Tavilla A, Santaquilani M, Sant M, EUROCARE Working Group (2009) Survival trends in European cancer patients diagnosed from 1988 to 1999. Eur J Cancer 45:1042–1066
Islami F, Moreira DM, Boffetta P, Freedland SJ (2014) A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. Eur Urol 66:1054–1064
Zu K, Giovannucci E (2009) Smoking and aggressive prostate cancer: a review of the epidemiologic evidence. Cancer Causes Control 20:1799–1810
Moreira DM, Aronson WJ, Terris MK, Kane CJ, Amling CL, Cooperberg MR, Boffetta P, Freedland SJ (2014) Cigarette smoking is associated with an increased risk of biochemical disease recurrence, metastasis, castration-resistant prostate cancer, and mortality after radical prostatectomy: results from the SEARCH database. Cancer 120:197–204
Murta-Nascimento C, Romero AI, Sala M, Lorente JA, Bellmunt J, Rodero NJ, Lloreta J, Hospital A, Burón A, Castells X, Macià F (2014) The effect of smoking on prostate cancer survival: a cohort analysis in Barcelona. Eur J Cancer Prev 24:335–339
Stone NN, Stock RG (2014) 15-year cause specific and all-cause survival following brachytherapy for prostate cancer: negative impact of long-term hormonal therapy. J Urol 192:754–759
Steinberger E, Kollmeier M, McBride S, Novak C, Pei X, Zelefsky MJ (2014) Cigarette smoking during external beam radiation therapy for prostate cancer is associated with an increased risk of prostate cancer-specific mortality and treatment-related toxicity. BJU Int. doi: 10.1111/bju.12969
Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E (2011) Smoking and prostate cancer survival and recurrence. JAMA 305:2548–2555
Joshu CE, Mondul AM, Meinhold CL, Humphreys EB, Han M, Walsh PC, Platz EA (2011) Cigarette smoking and prostate cancer recurrence after prostatectomy. J Natl Cancer Inst 103:835–838
Gong Z, Agalliu I, Lin DW, Stanford JL, Kristal AR (2008) Cigarette smoking and prostate cancer-specific mortality following diagnosis in middle-aged men. Cancer Causes Control 19:25–31
Pantarotto J, Malone S, Dahrouge S, Gallant V, Eapen L (2007) Smoking is associated with worse outcomes in patients with prostate cancer treated by radical radiotherapy. BJU Int 99:564–569
Dal Maso L, Zucchetto A, La Vecchia C, Montella M, Conti E, Canzonieri V, Talamini R, Tavani A, Negri E, Garbeglio A, Franceschi S (2004) Prostate cancer and body size at different ages: an Italian multicentre case-control study. Br J Cancer 90:2176–2180
Dal Maso L, Zucchetto A, Talamini R, Serraino D, Stocco CF, Vercelli M, Falcini F, Franceschi S (2008) Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer 123:2188–2194
D’Avanzo B, La Vecchia C, Katsouyanni K, Negri E, Trichopoulos D (1996) Reliability of information on cigarette smoking and beverage consumption provided by hospital controls. Epidemiology 7:312–315
Kalbfleisch JD, Prentice RL (2002) The statistical analysis of failure time data. Wiley, New York
Giovannucci E, Liu Y, Plats EA, Stampfer MJ, Willett WC (2007) Risk factors for prostate cancer incidence and progression in the health professional follow-up study. Int J Cancer 121:1571–1578
Sopori ML, Kozak W (1998) Immunomodulatory effects of cigarette smoke. J Neuroimmunol 83:148–156
Kalra R, Singh SP, Savage SM, Finch GL, Sopori ML (2000) Effects of cigarette smoke on immune response: chronic exposure to cigarette smoke impairs antigen-mediated signaling in T cells and depletes IP3-sensitive Ca(2+) stores. J Pharmacol Exp Ther 293:166–171
Crocetti E, AIRTUM Working Group (2007) Tumore della prostata: trend di incidenza e di mortalità. Epid Prev 31:100
Ho T, Howard LE, Vidal AC, Gerber L, Moreira D, McKeever M, Andriole G, Castro-Santamaria R, Freedland SJ (2014) Smoking and risk of low and high-grade prostate cancer: results from the REDUCE study. Clin Cancer Res 20:5331–5338
AIRTUM Working Group (2014) Italian cancer figures, report 2014: prevalence and cure of cancer in Italy. Epidemiol Prev 38(6 Suppl 1):1–122
Acknowledgments
The authors wish to thank Mrs. Luigina Mei for editorial assistance and Drs. Silvia Franceschi, Carlo La Vecchia, and Renato Talamini for design and conduction of the original case–control study. This work was partially funded by the Italian Association for Research on Cancer (AIRC IG No. 1468).
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The authors declare that they have no conflict of interest.
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For this retrospective study, formal consent is not required.
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Informed consent was obtained from all individual participants included in the study.
Additional information
Diego Serraino and Antonella Zucchetto have contributed equally to this work.
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Polesel, J., Gini, A., Dal Maso, L. et al. The negative impact of tobacco smoking on survival after prostate cancer diagnosis. Cancer Causes Control 26, 1299–1305 (2015). https://doi.org/10.1007/s10552-015-0624-2
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DOI: https://doi.org/10.1007/s10552-015-0624-2