Smoking and Prostate Cancer
Blah, blah, blah, everyone knows that smoking increases the risk of lung cancer. But if you’re a guy and you smoke, did you know that smoking raises your risk of prostate cancer? Not only that, but if you smoke and you get prostate cancer, you have a higher chance of dying from your cancer!
Let’s examine the data, starting with men who smoke. It’s estimated that in the U.S. nearly 12% of adults smoke cigarettes. That totals nearly 29 million people. Divide that by half (almost half of U.S. adults are male) and that gives roughly 14 million male smokers.
Now take the numbers for prostate cancer. Prostate cancer is the most common non-skin cancer in men. While lung cancer is the number one cancer killer in men, prostate cancer is in second place—and far more men have prostate cancer than lung cancer. National averages tell us that one out of every eight men will have prostate cancer in his lifetime, compared with one out of fifteen men for lung cancer. On average for prostate cancer, that means a 12.5% chance of being one of those patients. However, smoking increases the odds. It comes down to this: if you are a male smoker, you’re statistically more likely to get prostate cancer than lung cancer.
Of course, there are other risk factors for prostate cancer, and some are worse than others. For example, a family history of either prostate or breast cancer (yes, there’s a genetic link to breast cancer) is a red flag. In fact, prostate cancer in a first-degree family member (father, brother, son) means a man has a 50% risk of developing the disease! Another one is exposure to toxic substances, some of which are highly carcinogenic (cause cancer). For instance, Vietnam veterans exposed to Agent Orange have a 52% chance of developing prostate cancer. Did you know that of the 7,000 chemicals in tobacco smoke, 69 are known to be cancer-causing?
Two important research studies are cautionary tales for male smokers. A 2015 study of prostate cancer deaths compared patients who had never smoked with those who were smokers at the time of their diagnosis. The nonsmokers had lower death rates from their prostate cancer as well as all causes. It’s noteworthy that the risk of death increased based on more cigarettes per day and more years as a smoker. On top of that, on average the smokers were found to have more aggressive prostate cancer cell lines that are harder to treat successfully.
These findings are supported by a 2018 study of prostate cancer and smoking, which found a definite link between the two. Among the patients included in the study, current smokers who had treatment for their prostate cancer were 40% more likely to have their cancer come back, over 50% more likely to have their disease spread, and 89% more likely to die from their cancer.
Implications For Treatment
Prostate cancer is very treatable, especially when it is caught early. Treatment is most successful (and has the lowest side effect rate) when prostate cancer is still contained in the gland and not very aggressive yet. The bulkier the tumor, and the more aggressive the cell line, the more aggressive the treatment must be. In general, the most aggressive treatments are surgical removal (prostatectomy) and radiation (with or without hormone treatment). These treatments tend to have more urinary and sexual side effects, though many side effects eventually go away or are treatable. Since smokers may be found to have more aggressive disease at diagnosis, matching a treatment to their cancer may mean a form of either surgery or radiation.
However, if prostate cancer is caught when the tumor is small, of low aggression, and still localized within the gland, there are FDA-cleared treatments called “focal therapies” such as Focal Laser Ablation (FLA) that target just the tumor while sparing healthy tissue. This type of approach, guided by imaging, is done on an outpatient basis and has the least risk of side effects. Note that thorough diagnosis is a must in order to be sure a patient is qualified. A special caution for smokers who develop prostate cancer: If your doctor determines that you are a good candidate for a focal therapy, it is essential that you strictly adhere to your monitoring protocol after treatment, since smokers have a higher risk of their cancer coming back in the untreated part of the gland.
Best Investment In Your Prostate Health
Research has shown that the cancer-causing chemicals in cigarettes don’t just stay in the lungs. They are absorbed and travel throughout the body, eventually making their way to the prostate (and other organs) where they are irritants to the normal tissue, potentially leading to cancerous mutations in cells. If you’re a male smoker, it’s very important that you commit to an annual PSA blood test to screen for prostate cancer. Since your risk is higher, this is the easiest and cheapest way to monitor for the disease. And by the way, not to panic if your PSA number is higher than normal or rising. Before rushing to biopsy, have a special MRI of the prostate to visually see if there’s a suspicious area that needs a biopsy. If not, whew! Have your blood draw again at your next annual wellness visit.
Quitting smoking can be very challenging, both in terms of biological addiction and psychological dependence. However, a man’s prostate health depends on lifestyle wellness choices like diet and exercise—both proven to help prevent prostate cancer. If you’re a man and a smoker, stop smoking. The day you quit is your number one investment in protecting this small but important gland against cancer.
NOTE: This piece written by Dr. Dan Sperling
