Abstract
Cigarette smoking has been consistently associated with increased risk of overall mortality, but the importance of smoking for patients with prostate cancer (CaP) who are candidates for curative radical prostatectomy (RP) has received less attention. This retrospectively designed cohort study investigated the association of smoking history at RP with subsequent CaP treatment outcomes and overall mortality. A total of 1981 patients who underwent RP at Roswell Park Cancer Institute (RPCI) between 1993 and 2014 were studied. Smoking history was considered as a risk factor for overall mortality as well as for currently accepted CaP treatment outcomes (biochemical failure, treatment failure, distant metastasis, and disease‐specific mortality). The associations of smoking status with these outcomes were tested by Cox proportional hazard analyses. A total of 153 (8%) patients died during follow‐up. Current smoking at diagnosis was a statistically significant predictor of overall mortality after RP (current smokers vs. former and never smokers, hazards ratio 2.07, 95% confidence interval [CI]: 1.36–3.14). This association persisted for overall mortality at 3, 5, and 10 years (odds ratios 2.07 [95% CI: 1.36–3.15], 2.05 [95% CI: 1.35–3.12], and 1.8 [95% CI: 1.18–2.74], respectively). Smoking was not associated with biochemical failure, treatment failure, distant metastasis, or CaP‐specific mortality, and the association of smoking with overall mortality did not appear to be functionally related to treatment or biochemical failure, or to distant metastasis. Smoking is a non‐negligible risk factor for death among CaP patients who undergo RP; patients who smoke are far more likely to die of causes other than CaP.
Highlights
CaP, the most commonly diagnosed noncutaneous cancer in men, accounts for 13.3% of new cancer cases and 4.7% of cancer deaths in the United States each year [1]
The association of smoking with increased overall mortality in these patients with operable CaP does not appear to be mediated by CaP-specific outcomes—biochemical failure, treatment failure, distant metastasis, or disease- specific mortality
Current smokers had a higher diagnostic PSA, and were more likely to have lymph node metastases and positive surgical margins, smoking was unrelated to treatment failure, presence of distant metastasis, or disease-specific mortality in any analysis with these factors taken into account
Summary
CaP, the most commonly diagnosed noncutaneous cancer in men, accounts for 13.3% of new cancer cases and 4.7% of cancer deaths in the United States each year [1]. Since the implementation of prostate-s pecific antigen (PSA) screening for early detection, many patients diagnosed with CaP die of other diseases, cardiovascular disease, which has been unequivocally linked to smoking [2]. Smoking has not been shown to increase CaP risk, there is concern that smoking may increase CaP aggressiveness and risk of CaP-specific mortality [3]. This study tested the association of smoking history at RP. Smoking History and Prostate Cancer Outcome (current, former, never), among well-annotated and carefully followed RP patients, with multiple, currently recognized measures of CaP-specific outcomes and overall mortality
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