#EAU15 - Smokers at twice risk of prostate cancer recurring after surgery

MADRID, SPAIN (Press Release) - March 21, 2015 - Current smokers, and those who have quit smoking less than 10 years previously, have twice the risk of a recurrence of prostate cancer after surgery, according to new research presented at the European Association of Urology conference in Madrid.

Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Around 30% of all prostate cancer patients treated with radical prostatectomy experience biochemical recurrence (defined by an increase in PSA, prostate specific antigen) within 10 years after surgery.

eauAn international group of scientists and clinicians from the USA and Europe retrospectively looked at biochemical prostate cancer recurrence - in 7191 men who had had their prostate removed by radical prostatectomy. Of these men, roughly a third were never smokers (2513, or 34.9%), a third were former smokers (2269, or 31.6%) and a third were current smokers (3409, or 33.5%). These patients were followed up for an average of 28 months.

The results showed that after a median of 28 months, current smokers had around double (HR 2.26) the chance of the cancer recurring than did patients who had never smoked (see abstract below for full results). Even those who had quit smoking within the last 10 years still had a significantly higher risk of cancer recurrence, at about the same level (HR 2.03) as that for current smokers. It wasn’t until 10 years after a patient had quit smoking that the risk of cancer recurrence dropped significantly.

According to lead researcher Dr Malte Rieken (University Hospital, Basel, Switzerland):

“This is a new analysis, but it seems to confirm results we have seen in many other types of cancer: basically, smoking increases the risk of cancer recurrence after initial treatment. Prostate cancer mortality varies widely throughout Europe. The fact that cancer recurrence can vary so dramatically due to smoking is probably one of the factors which may contribute to differences in prostate cancer mortality. It’s just another reason not to smoke at all, but the fact that the risk drops after 10 years means that anyone who has prostate cancer, would be well advised to quit immediately.”

Commenting former EAU Secretary-General, Per-Anders Abrahamsson (Malmo, Sweden) said:

“Prostate cancer is a leading cause of cancer death for man in the western world. A number of studies have addressed how diet and environmental factors affect the risk of prostate cancer. This is the first report that clarifies that smoking increases the risk of prostate cancer recurring after surgery and, therefore, a major step forward to advise our patients to stop smoking when diagnosed with prostate cancer.”

Notes for editors

PLEASE MENTION THE EUROPEAN ASSOCIATION OF UROLOGY CONGRESS IN ANY STORY RESULTING FROM THIS PRESS RELEASE

Dr Malte Rieken, email

EAU Press Officer, Tom Parkhill telephone +39 349 238 8191

EAU ex-Secretary General, Per-Anders Abrahamsson

BACKGROUND
European prostate cancer incidence and mortality statistics are available here: http://eco.iarc.fr/eucan/CancerOne.aspx?Cancer=29&Gender=1

The 15th European Association of Urology conference takes place in Madrid from 20-24th March. This is the largest and most important urology congress in Europe, with up to 13,000 expected to attend. Conference website http://eaumadrid2015.uroweb.org/

Abstract Nr: 508
Association of cigarette smoking and smoking cessation with biochemical recurrence in patients treated with radical prostatectomy for prostate cancer

Rieken, M.,1 Kluth, L.,2 Fajkovic, H.,3 Karakiewicz, P.,4 Lotan, Y.,5 Seitz, C.,3 Briganti, A.,6 Roupret, M.,7 Loidl, W.,8 Lee, R.,9 Trinh, Q-D.,10 Nyirady, P.,11 Bachmann, A.,1 Pourmand, G-R.,12 Shariat, S.F.3
1University Hospital Basel, Dept. of Urology, Basel, Switzerland, 2University Medical-Center Hamburg-Eppendorf, Dept. of Urology, Hamburg, Germany, 3Medical University of Vienna, Dept. of Urology, Vienna, Austria, 4University of Montreal, Dept. of Urology, Montreal, Canada, 5University of Texas Southwestern Medical Center, Dept. of Urology, Dallas, United States of America, 6San Raffaele Scientific Institute, Urological Research Institute, Milan, Italy, 7AP-HP, Hopital Pitie-Salpetriere, Dept. of Urology, Paris, France, 8Krankenhaus Barmherzige Schwestern, Prostate Cancer Center, Linz, Austria, 9Weill Cornell Medical College, New York Presbyterian Hospital, Dept. of Urology, New York, United States of America, 10Brigham and Women's Hospital, Dana-Farber Cancer Institute, Dept. of Urology, Boston, United States of America, 11Semmelweis University, Dept. of Urology, Budapest, Hungary, 12Tehran University of Medical Sciences, Dept. of Urology, Tehran, Iran

Introduction & Objectives
Cigarette smoking seems to be associated with prostate cancer (PCa) incidence and mortality. We aimed to elucidate the association of pretreatment smoking status, cumulative exposure, and time since smoking cessation on the risk of biochemical recurrence (BCR) of patients with clinically localized PCa treated with radical prostatectomy (RP).

Material & Methods
Retrospective analysis of 7191 patients treated with RP for PCa between 2000 and 2011. Clinicopathologic and smoking variables, including smoking status, number of cigarettes per day, duration in years, and time since smoking cessation were collected. Uni- and multivariable Cox regression analyses assessed the association of smoking with risk of BCR.

Results
Of 7191 patients, 2513 (34.9%), 2269 (31.6%) and 2409 (33.5%) were never, former and current smokers, respectively. Current smokers had a significantly higher percentage of patients harboring biopsy and RP Gleason-Score ≥8 tumors (p<0.0001). Seminal vesicle invasion was more frequently detected in current smokers compared to former or never smokers (p<0.0001). Median follow-up was 28 months (Interquartile range 14-42). In multivariable Cox regression analysis adjusted for standard clinicopathologic features, former smoking (HR 2.03, 95% CI 1.63-2.53, p<0.0001) and current smoking (HR 2.26, 95% CI 1.83-2.80, p<0.0001) were associated with increased risk of BCR compared with non-smokers. Smoking cessation was significantly associated with BCR in univariable analysis (Image). Smoking cessation ≥ 10 years mitigated the risk of BCR in multivariable analyses (HR 1.20, 95% CI 0.86-1.68, p=0.29), whereas smoking cessation ≤ 4 years (HR 2.19, 95% CI 1.70-2.81, p<0.0001) and between 5-9 years (HR 2.39, 95% CI 1.79-3.17, p<0.0001) were associated with increased risk of BCR compared with non-smokers. In multivariable analysis, no significant association between cumulative exposure and risk of BCR could be detected.

Conclusions
Smoking is associated with increased risk of BCR after RP. The effect of smoking on BCR seems to be mitigated by ≥10 years of smoking cessation.

Funding: no external funding was received for this work.

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European Association of Urology

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