In the June issue of JAMA, Dr. Stacey Kenfield and colleagues report that men who are smoking at the time of a CaP diagnosis have increased CaP-specific, overall and cardiovascular disease (CVD) mortality and higher recurrence rates.
The database used was the Health Professionals follow-Up Study, a prospective cohort of 51,529 male health professionals enrolled by 1986. They provided survey data at enrollment and during follow-up about medical history and health-related risk factors. Smoking status was assessed every 2 years and compiled with quantity of cigarettes smoked and age of smoking onset. A total of 5,366 men who developed CaP had adequate data for assessment and were free of cancers at the time of enrollment. The investigators used multinomial logistical regression models and adjusted for age at diagnosis in 5-year age categories to test whether there were differences in clinical stage and clinical Gleason score by smoking status at diagnosis. Hazard ratios were calculated for risk of death.
Among the 5,366 men with CaP, 1,630 deaths were documented; 524 (32%) from CaP, 416 (26%) from CVD, and 878 men experienced a biochemical recurrence. The median time from diagnosis to censoring was 8.1 years for those with CaP recurrence and 12.2 for those without. They found that compared with those who had never smoked, current smokers had higher clinical stage and grade; for example 14.7% of current smokers had stage T3 disease or higher at diagnosis compared with 8.3% of never smokers and 16% of current smokers had Gleason score 7 or higher compared with 10.7% of never smokers. Current smokers had similar body mass indices compared with never smokers, but consumed more alcohol, coffee and saturated fat. At 10 years, the proportions free of CaP-specific death were 89.8% for never smokers and 82.7% for current smokers. For CaP recurrence, the rate was 26.4% for never smokers and 38.3% for current smokers. At 10 years, 74.8% of never smokers were alive compared with 54.8% of current smokers. The HR for current smokers’ risk of death from CaP, CVD, all-cause mortality and recurrence compared with never smokers was 1.80, 2.13, 2.28, and 1.61, respectively. Former smokers had an HR for total mortality of 1.23, but were not at increased risk for other endpoints.
Kenfield SA, Stampfer MJ, Chan JM, Giovannucci E
JAMA. 2011 Jun 22;305(24):2548-55