Smoking and Prostate Cancer: A Systematic Review

Context: Cigarette smoking is the leading cause of death from cancer, although the relationship between smoking and prostate cancer (PCa) is controversial. Objective: To evaluate the available evidence of the role of cigarette smoking and PCa development and progression and to discuss possible clinical implications for PCa management. Evidence acquisition: A PubMed search for relevant articles published between 2004 and September 2014 was performed by combining the following PICO (patient population, intervention, comparison, outcome) terms: male, smoking, prostate, prostate cancer, prevention, diagnosis, treatment, and prognosis. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Evidence synthesis: The association between cigarette smoking and PCa incidence is controversial, particularly in recent series. Current cigarette smoking is associated with an increased risk of PCa death, and the number of cigarettes smoked per day had a dose-response association with PCa mortality. Smokers present a higher risk of biochemical or distant failure after PCa treatment. Several biological mechanisms behind these associations have been proposed, although the molecular mechanisms remain unclear. Further research is required to better understand the role of smoking on PCa development and progression and, particularly, to evaluate the possible effect of smoking cessation on PCa management. Conclusions: Data from the peer-reviewed literature suggested an association of smoking and aggressive PCa. Although the pathophysiology underlying this association remains unclear, smokers presented higher PCa mortality and worse outcome after treatment. Smoking-cessation counseling should be implemented for patients with PCa, although its effect on PCa progression should be investigated. Patient summary: We looked at the association between smoking and prostate cancer (PCa). Smokers have a higher risk of PCa mortality and worse outcomes after treatment. Smoking cessation should be encouraged in men with or at risk of having PCa.