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Smoking during prostate cancer treatment increases risk for metastases, mortality
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Patients who smoked during treatment for localized prostate cancer faced an increased risk for biochemical recurrence, metastasis and cancer-specific death, according to findings published in JAMA Oncology.
“Tobacco smoking is known as a preventable risk factor for the development and mortality of several genitourinary cancers, such as bladder cancer, upper tract urothelial carcinoma and renal cell carcinoma,” Sharokh F. Shariat, MD, department chair and professor of the department of urology at Medical University of Vienna, and colleagues wrote. “In contrast, the effect of tobacco consumption on the incidence of prostate cancer is still a matter of debate. Nevertheless, the association between cigarette smoking and prostate cancer mortality seems to be robust.”
The researchers performed a systematic review of the PubMed, MEDLINE, Embase and Cochrane Library databases to identify 5,157 articles published between January 2000 and March 2017 that examined associations between smoking status and prognosis of patients receiving curative treatment for localized prostate cancer.
Qualitative analysis included 16 articles and quantitative analysis included 11. All articles in the review were observational, nonrandomized studies.
The included studies comprised 4,202 smokers (18.2%). Median follow-up was 72 months.
Current smokers appeared at a significantly greater risk for biochemical recurrence based on data from 10 studies (HR = 1.4; 95% CI, 1.18-1.66). Former smokers also had greater risk, based on data from seven studies (HR = 1.19; 95% CI, 1.09-1.3).
Three studies found that current smokers had a higher risk for metastasis (HR = 2.51; 95% 1.8-3.51), and five studies found that smokers had a greater risk for cancer-specific mortality (HR = 1.61; 95% CI, 0.65-3.97). These risks did not extend to former smokers (metastasis in two studies: HR = 1.61; 95% CI, 0.65-3.97; cancer-specific mortality in four studies, HR = 1.05; 95% CI, 0.81-1.37).
“Our findings encourage radiation oncologists and urologists to counsel patients to stop smoking, using primary prostate cancer treatment as a teachable moment,” the researchers wrote. “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.”
Clinicians should be “hypervigilant” in urging patients to quit smoking, Stephen J. Freedland, MD, director of Center for Integrated Research in Cancer and Lifestyle and professor of surgery at Cedars-Sinai Medical Center, wrote in an accompanying editorial.
“If all of us remembered we are physicians first and oncologists and/or prostate cancer experts second, we will realize we are uniquely poised to help our patients, as the time of a new cancer diagnosis is a teachable moment when patients are very receptive to overall health advice,” Freedland wrote. “Indeed, using a cancer diagnosis to urge patients to stop smoking may be just what the doctor ordered.” – by Andy Polhamus
Disclosures: Shariat reports full or partial ownership of several patents related to determining the prognosis of prostate and genitourinary cancers, as well as advisory or speaking roles with Astellas, Cepheid, Eli Lilly, Ipsen, Jansen, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi and Wolff. The other authors and Freedland report no relevant financial disclosures.
Perspective
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This study examined the association of cigarette smoking on the outcomes of men with prostate cancer who underwent standard treatment by surgery or radiotherapy. The authors found clear increased risks for biochemical recurrence, metastasis and cancer-specific mortality among current smokers at the time of treatment, compared with never smokers, independent of treatment approach. Former smokers demonstrated a lesser amount of increased risk for biochemical recurrence; however, researchers observed no significant relationship for former smokers regarding development of metastasis or cancer-specific mortality. Despite interest in quantifying risk by level of cigarette smoking exposure, inadequate data existed to identify any association to outcome with degree of cumulative exposure for former smokers, or regarding men who achieved different periods of smoking cessation at the point when they underwent treatment.
The study has recognized limitations in applying studies from observational and nonrandomized cohorts, where populations and methods varied widely, and extracted data were heterogeneous and not always comparable. The study reinforces the benefit of including a discussion on smoking cessation during counseling of men identified with prostate cancer.
Fox Chase Cancer Center
Disclosure: Chen reports no relevant financial disclosures.
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