Kate Johnson

March 23, 2015

MADRID — Men with prostate cancer who have smoked in the previous 10 years have twice the risk for disease recurrence within 28 months of radical prostatectomy as men who have not smoked, according to a new study.

"Our results and the available evidence from other cancers suggest that prostate cancer patients should be counseled on the detrimental effects of smoking on outcomes following radical prostatectomy, and on the benefits of smoking cessation, said lead investigator Malte Rieken, MD, from University Hospital in Basel, Switzerland.

However, Dr Rieken acknowledged that smoking cessation might be a hard sell to patients, given that this study suggests a positive effect only after 10 years of not smoking.

He presented the study results here at the European Association of Urology 30th Annual Congress.

"I totally agree that smoking cessation at the time of diagnosis will most probably not have a major impact, given the natural history of prostate cancer," he told Medscape Medical News. "Nevertheless, urologists and healthcare practitioners need to play a more active role in educating smokers regarding the risk of smoking and in counseling patients on the benefits of smoking cessation."

The retrospective analysis involved 7191 American and European men with prostate cancer who underwent radical prostatectomy from 2000 to 2011.

The distribution of men who were current, former, and never smokers was a roughly equal.

The risk for biochemical recurrence at 28 months was twice as high in current smokers as in never smokers (hazard ratio [HR], 2.26; P < .0001), and twice as high in those who had smoked in the previous 10 years (HR, 2.03; P < .0001).

Table. Recurrence-Free Survival Rates

Recurrence-Free Survival Current Smokers, % Previous Smokers, % Never Smokers, %
5 years 81 83 91
7 years 72 77 84


Compared with never smokers, there was no significant difference in biochemical recurrence between smokers who had quit for 4 years and those who had quit for 5 to 9 years (HR, 2.19 vs 2.39; P < .001). The risk only dropped once smoking cessation hit the 10-year mark (HR, 1.20; P = .29).

The detrimental effect of smoking has been seen in other urothelial cancers, such as bladder cancer and cancer of the upper urinary tract. In fact, the association between duration of smoking cessation and risk for biochemical recurrence has been well characterized in these cancers, said Dr Rieken.

However, the association between cessation and recurrence has not been previously described in prostate cancer, he reported.

This study is important and "is similar to what we reported recently in a large cohort of prostate cancer patients treated with radiotherapy," said Michael Zelefsky MD, professor of radiation oncology and chief of brachytherapy services at the Memorial Sloan Kettering Cancer Center in New York City (BJU Int. Published online October 23, 2014).

"In our study of more than 2300 patients treated with radiotherapy, we observed that among smokers, there was a significant increase in distant metastases and prostate-related deaths," he told Medscape Medical News.

"Collectively, these data suggest that smoking may cause molecular changes within tumor clonogens, leading to the development of a more aggressive disease phenotype," Dr Zelefsky explained. "It is clear that smoking-cessation programs would be important for all patients considering local therapy for their prostate cancer."

Dr Rieken and Dr Zelefsky have disclosed no relevant financial relationships.

European Association of Urology (EAU) 30th Annual Congress: Abstract 508. Presented March 22, 2015.


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