Smoking Increases Risk of Prostate Cancer Recurrence After Surgery

Smoking is a risk factor for biochemical recurrence of prostate cancer (PCa) following radical prostatectomy (RP), new study findings suggest.

In a retrospective study of 6,538 PCa patients who underwent RP, a team led by Malte Rieken, MD, of University Hospital Basel in Basel, Switzerland, and Shahrokh F. Shariat, MD, of the Medical University of Vienna in Vienna, Austria, found that current and former smokers had a significant 1.8 and 1.6 times higher risk of biochemical recurrence than non-smokers. Smoking cessation for 10 or more years mitigated the risk. The 5-year recurrence-free survival rates for current, former, and never smokers were 83%, 84%, and 90%, respectively.

“Smokers should be counseled regarding the detrimental effects of smoking on PCa prognosis,” the investigators wrote in a report published online ahead of print in European Urology. “Urologists need to play a broader role in the health care management of our population.”

Of the 6,538 patients, 2,214 (34%), 2,086 (32%), and 2,238 (34%) were current, former, and never smokers, respectively. The median follow-up for men not experiencing biochemical recurrence was 28 months. The 3 groups were comparable with respect to Gleason score, extracapsular extension, seminal vesicle invasion, and positive surgical margins.

The researchers observed no significant association between cumulative smoking exposure and risk of biochemical recurrence.

Study limitations include the retrospective design and potential recall bias with regard to smoking history.

The new study adds to a growing body of evidence that smoking is associated with worse outcomes in patients with urologic malignancies. For example, at the recent American Urological Association annual meeting, a team led by Akshay Sood, MD, of of the Vattikuti Urology Institute, Henry Ford Hospital, Detroit, presented data showing that current and former smokers who underwent RP for PCa had increased odds of pulmonary and renal complications compared with non-smokers. Among patients who underwent radical cystectomy, current smokers had increased odds of re-intervention and former smokers had increased odds of readmission compared with non-smokers.