Cancer Causes & Control

, Volume 20, Issue 10, pp 1967–1974 | Cite as

Cigarette smoking and risk of prostate cancer among Singapore Chinese

  • Lesley M. Butler
  • Renwei Wang
  • Alvin S. Wong
  • Woon-Puay Koh
  • Mimi C. Yu
Original paper


Prospective epidemiologic studies conducted in Western populations support an association between current smoking and aggressive subtypes of prostate cancer. In Singapore, where prostate-specific antigen is not used for population-wide screening, prostate cancer incidence has tripled within the past two decades. Using Cox regression methods, we examined the relationship between smoking and prostate cancer established between 1993 and 1998 in a cohort of 27,293 Singapore Chinese men. As of December 2006, 250 incident prostate cancer cases were diagnosed. In our cohort, 42.2% reported never smoking cigarettes, 15.7% quit over 5 years ago (long-term former), 5.7% quit within the past 5 years (recent former), and 36.4% were current smokers. From multivariable models, we observed no association with smoking status, age at starting to smoke, years smoked, or number of cigarettes per day. Among recent former and current smokers combined, we observed a small positive association for earlier age at starting to smoke that was somewhat stronger for nonadvanced disease (hazard ratio = 1.63, 95% confidence interval: 0.85, 3.12, for <15 years versus nonsmokers). Smoking was not a major risk factor for prostate cancer in our Singapore Chinese cohort, a traditionally low risk population with parallel increases in incidence and mortality.


Cigarette smoking Epidemiology Prospective study Prostate cancer Singapore Chinese 


  1. 1.
    Chen TT, Heidelberger C (1969) Quantitative studies on the malignant transformation of mouse prostate cells by carcinogenic hydrocarbons in vitro. Int J Cancer 4(2):166–178CrossRefPubMedGoogle Scholar
  2. 2.
    Guttenplan JB, Chen M, Kosinska W, Thompson S, Zhao Z, Cohen LA (2001) Effects of a lycopene-rich diet on spontaneous and benzo[a]pyrene-induced mutagenesis in prostate, colon and lungs of the lacZ mouse. Cancer Lett 164(1):1–6CrossRefPubMedGoogle Scholar
  3. 3.
    Hecht SS (2003) Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev 3(10):733–744Google Scholar
  4. 4.
    Finnstrom N, Bjelfman C, Soderstrom TG et al (2001) Detection of cytochrome P450 mRNA transcripts in prostate samples by RT-PCR. Eur J Clin Invest 31(10):880–886CrossRefPubMedGoogle Scholar
  5. 5.
    Murray GI, Taylor VE, McKay JA et al (1995) The immunohistochemical localization of drug-metabolizing enzymes in prostate cancer. J Pathol 177(2):147–152CrossRefPubMedGoogle Scholar
  6. 6.
    Nishimura M, Naito S (2006) Tissue-specific mRNA expression profiles of human phase I metabolizing enzymes except for cytochrome P450 and phase II metabolizing enzymes. Drug Metab Pharmacokinet 21(5):357–374CrossRefPubMedGoogle Scholar
  7. 7.
    Rybicki BA, Rundle A, Savera AT, Sankey SS, Tang D (2004) Polycyclic aromatic hydrocarbon-DNA adducts in prostate cancer. Cancer Res 64(24):8854–8859CrossRefPubMedGoogle Scholar
  8. 8.
    Scherer G, Frank S, Riedel K, Meger-Kossien I, Renner T (2000) Biomonitoring of exposure to polycyclic aromatic hydrocarbons of nonoccupationally exposed persons. Cancer Epidemiol Biomarkers Prev 9(4):373–380PubMedGoogle Scholar
  9. 9.
    Hickey K, Do KA, Green A (2001) Smoking and prostate cancer. Epidemiol Rev 23(1):115–125PubMedGoogle Scholar
  10. 10.
    Giovannucci E, Rimm EB, Ascherio A et al (1999) Smoking and risk of total and fatal prostate cancer in United States health professionals. Cancer Epidemiol Biomarkers Prev 8(4 Pt):277–282PubMedGoogle Scholar
  11. 11.
    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(1):25–31CrossRefPubMedGoogle Scholar
  12. 12.
    Hsing AW, McLaughlin JK, Schuman LM et al (1990) Diet, tobacco use, and fatal prostate cancer: results from the Lutheran Brotherhood Cohort study. Cancer Res 50(21):6836–6840PubMedGoogle Scholar
  13. 13.
    Rodriguez C, Tatham LM, Thun MJ, Calle EE, Heath CW Jr (1997) Smoking and fatal prostate cancer in a large cohort of adult men. Am J Epidemiol 145(5):466–475PubMedGoogle Scholar
  14. 14.
    Coughlin SS, Neaton JD, Sengupta A (1996) Cigarette smoking as a predictor of death from prostate cancer in 348, 874 men screened for the multiple risk factor intervention trial. Am J Epidemiol 143(10):1002–1006PubMedGoogle Scholar
  15. 15.
    Jin F, Devesa SS, Chow WH et al (1999) Cancer incidence trends in urban shanghai, 1972–1994: an update. Int J Cancer 83(4):435–440CrossRefPubMedGoogle Scholar
  16. 16.
    US Cancer Statistics Working Group (2007) United States Cancer Statistics: 1999–2004 Incidence and Mortality Web-based Report. Atlanta, US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute, available at
  17. 17.
    Seow A, Koh WP, Chia KS, Shi LM, Lee HP, Shanmugaratnam K (2004) Trends in cancer incidence in Singapore 1968–2002: Singapore Cancer Registry, Report No. 6Google Scholar
  18. 18.
    Sim HG, Cheng CW (2005) Changing demography of prostate cancer in Asia. Eur J Cancer 41(6):834–845CrossRefPubMedGoogle Scholar
  19. 19.
    Cheng I, Yu MC, Koh WP et al (2005) Comparison of prostate-specific antigen and hormone levels among men in Singapore and the United States. Cancer Epidemiol Biomarkers Prev 14(7):1692–1696CrossRefPubMedGoogle Scholar
  20. 20.
    Singapore Urological Association (2004) Guidelines: the management of prostatic cancer. Accessed 13 Oct 2008
  21. 21.
    Jacobsen SJ, Katusic SK, Bergstralh EJ et al (1995) Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing. Jama 274(18):1445–1449CrossRefPubMedGoogle Scholar
  22. 22.
    Potosky AL, Miller BA, Albertsen PC, Kramer BS (1995) The role of increasing detection in the rising incidence of prostate cancer. JAMA 273(7):548–552CrossRefPubMedGoogle Scholar
  23. 23.
    Etzioni R, Berry KM, Legler JM, Shaw P (2002) Prostate-specific antigen testing in black and white men: an analysis of medicare claims from 1991–1998. Urology 59(2):251–255CrossRefPubMedGoogle Scholar
  24. 24.
    Yao SL, Lu-Yao G (2002) Understanding and appreciating overdiagnosis in the PSA era. J Natl Cancer Inst 94(13):958–960PubMedGoogle Scholar
  25. 25.
    Loeb S, Gonzalez CM, Roehl KA et al (2006) Pathological characteristics of prostate cancer detected through prostate specific antigen based screening. J Urol 175(3 Pt 1):902–906CrossRefPubMedGoogle Scholar
  26. 26.
    Epstein JI, Walsh PC, Carmichael M, Brendler CB (1994) Pathologic and clinical findings to predict tumor extent of nonpalpable (stage T1c) prostate cancer. Jama 271(5):368–374CrossRefPubMedGoogle Scholar
  27. 27.
    Yuan JM, Stram DO, Arakawa K, Lee HP, Yu MC (2003) Dietary cryptoxanthin and reduced risk of lung cancer: the Singapore Chinese health study. Cancer Epidemiol Biomarkers Prev 12(9):890–898PubMedGoogle Scholar
  28. 28.
    Parkin DM, Whelan SL, Ferlay J, Teppo L, De Thomas (2003) Cancer incidence in five continents. International Agency for Research on Cancer, LyonGoogle Scholar
  29. 29.
    Greene F, Page D, Fleming I et al (2002) AJCC cancer staging manual, 6th edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  30. 30.
    D’Amico AV, Whittington R, Malkowicz SB et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280(11):969–974CrossRefPubMedGoogle Scholar
  31. 31.
    Hankin JH, Stram DO, Arakawa K et al (2001) Singapore Chinese health study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer 39(2):187–195CrossRefPubMedGoogle Scholar
  32. 32.
    Cox D (1972) Regression models and life tables. J Roy Stat Soc B 18:7–220Google Scholar
  33. 33.
    Lee HP, Ling A, Yew KC et al (2007) Trends in cancer incidence in Singapore 2001–2005, Singapore Cancer Registry, Interim ReportGoogle Scholar
  34. 34.
    Shankar A, Yuan JM, Koh WP, Lee HP, Yu MC (2008) Morbidity and mortality in relation to smoking among women and men of Chinese ethnicity: the Singapore Chinese health study. Eur J Cancer 44(1):100–109CrossRefPubMedGoogle Scholar
  35. 35.
    Dallongeville J, Marecaux N, Fruchart JC, Amouyel P (1998) Cigarette smoking is associated with unhealthy patterns of nutrient intake: a meta-analysis. J Nutr 128(9):1450–1457PubMedGoogle Scholar
  36. 36.
    Marangon K, Herbeth B, Lecomte E et al (1998) Diet, antioxidant status, and smoking habits in French men. Am J Clin Nutr 67(2):231–239PubMedGoogle Scholar
  37. 37.
    Subar AF, Harlan LC, Mattson ME (1990) Food and nutrient intake differences between smokers and non-smokers in the US. Am J Public Health 80(11):1323–1329CrossRefPubMedGoogle Scholar
  38. 38.
    Koh WP, Yuan JM, Sun CL, Lee HP, Yu MC (2005) Middle-aged and older Chinese men and women in Singapore who smoke have less healthy diets and lifestyles than nonsmokers. J Nutr 135(10):2473–2477PubMedGoogle Scholar
  39. 39.
    Giovannucci E, Liu Y, Platz EA, Stampfer MJ, Willett WC (2007) Risk factors for prostate cancer incidence and progression in the health professionals follow-up study. Int J Cancer 121(7):1571–1578CrossRefPubMedGoogle Scholar
  40. 40.
    Michnovicz JJ, Hershcopf RJ, Naganuma H, Bradlow HL, Fishman J (1986) Increased 2-hydroxylation of estradiol as a possible mechanism for the anti-estrogenic effect of cigarette smoking. N Engl J Med 315(21):1305–1309PubMedCrossRefGoogle Scholar
  41. 41.
    MacMahon B, Trichopoulos D, Cole P, Brown J (1982) Cigarette smoking and urinary estrogens. N Engl J Med 307(17):1062–1065PubMedGoogle Scholar
  42. 42.
    Moyad MA (2002) Is obesity a risk factor for prostate cancer, and does it even matter? A hypothesis and different perspective. Urology 59(4 Suppl 1):41–50CrossRefPubMedGoogle Scholar
  43. 43.
    Barrett-Connor E, Khaw KT (1987) Cigarette smoking and increased endogenous estrogen levels in men. Am J Epidemiol 126(2):187–192PubMedGoogle Scholar
  44. 44.
    Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Willett WC (1997) Height, body weight, and risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 6(8):557–563PubMedGoogle Scholar
  45. 45.
    Diamandis EP, Yu H (1996) Does prostate cancer start at puberty? J Clin Lab Anal 10(6):468–469CrossRefPubMedGoogle Scholar
  46. 46.
    Ross RK, Henderson BE (1994) Do diet and androgens alter prostate cancer risk via a common etiologic pathway? J Natl Cancer Inst 86(4):252–254CrossRefPubMedGoogle Scholar
  47. 47.
    Prins GS, Putz O (2008) Molecular signaling pathways that regulate prostate gland development. Differentiation 76(6):641–659CrossRefPubMedGoogle Scholar
  48. 48.
    Prins GS (2008) Endocrine disruptors and prostate cancer risk. Endocr Relat Cancer 15(3):649–656CrossRefPubMedGoogle Scholar
  49. 49.
    Smith TL, Merry ST, Harris DL et al (2007) Species-specific testicular and hepatic microsomal metabolism of benzo(a)pyrene, an ubiquitous toxicant and endocrine disruptor. Toxicol In Vitro 21(4):753–758CrossRefPubMedGoogle Scholar
  50. 50.
    Archibong AE, Ramesh A, Niaz MS, Brooks CM, Roberson SI, Lunstra DD (2008) Effects of benzo(a)pyrene on intra-testicular function in F-344 rats. Int J Environ Res Public Health 5(1):32–40CrossRefPubMedGoogle Scholar
  51. 51.
    Andersson SO, Baron J, Wolk A, Lindgren C, Bergstrom R, Adami HO (1995) Early life risk factors for prostate cancer: a population-based case–control study in Sweden. Cancer Epidemiol Biomarkers Prev 4(3):187–192PubMedGoogle Scholar
  52. 52.
    Lodde M, Harel F, Lacombe L, Fradet Y (2008) Substratification of high-risk localised prostate cancer treated by radical prostatectomy. World J Urol 26(3):225–229CrossRefPubMedGoogle Scholar
  53. 53.
    Boorjian SA, Karnes RJ, Rangel LJ, Bergstralh EJ, Blute ML (2008) Mayo clinic validation of the D’amico risk group classification for predicting survival following radical prostatectomy. J Urol 179(4):1354–1360 discussion 1360-1351CrossRefPubMedGoogle Scholar
  54. 54.
    Nock NL, Liu X, Cicek MS et al (2006) Polymorphisms in polycyclic aromatic hydrocarbon metabolism and conjugation genes, interactions with smoking and prostate cancer risk. Cancer Epidemiol Biomarkers Prev 15(4):756–761CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Lesley M. Butler
    • 1
  • Renwei Wang
    • 2
  • Alvin S. Wong
    • 3
  • Woon-Puay Koh
    • 4
  • Mimi C. Yu
    • 2
  1. 1.Department of Environmental and Radiological Health SciencesColorado State UniversityFort CollinsUSA
  2. 2.The Masonic Cancer CenterUniversity of MinnesotaMinneapolisUSA
  3. 3.National University HospitalSingaporeSingapore
  4. 4.Department of Epidemiology and Public HealthNational University of SingaporeSingaporeSingapore

Personalised recommendations