Smoking increases the risk of biochemical recurrence after prostate cancer surgery

Smoking is a risk factor for many tumors, but it seems to be controversial in prostate cancer (PCa). Some studies even show that current smoking status can reduce the risk of PCa. At the same time, biochemical recurrence after PCa radical surgery is also an important problem faced by PCa patients. So, what is the relationship between smoking and biochemical recurrence?

Recently, Rieken and other scholars from WeillCornell Medical College in the United States explored the correlation between biochemical recurrence of patients after radical resection of PCa and preoperative smoking status, cumulative smoking exposure, and time before quitting smoking. The results showed that smoking can increase the risk of biochemical recurrence of PCa, but quitting smoking for more than 10 years can reduce this risk. The article was published in the recent European Urology. This retrospective study included 6538 patients who underwent radical resection of PCa (negative lymph node metastasis) from 2000 to 2011, and these patients did not receive neoadjuvant chemotherapy.

The research indicators included clinical pathology and smoking-related variables such as smoking status, number of cigarettes smoked per day (CPD), duration and time to quit smoking. The primary endpoint was the occurrence of biochemical recurrence, that is, PSA>0.2ng/ml for two consecutive follow-ups. The analysis results showed that among the 6538 patients, the number of never, former and current smokers were 2238 (34%), 2086 (32%) and 2214 (34%), respectively, and the patients were divided into three groups based on this. The median follow-up time for patients without biochemical recurrence was 28 months. There were no significant differences in Gleason scores, extracapsular infiltration, seminal vesicle infiltration, and positive surgical margins among the three groups of patients.

The five-year biochemical recurrence-free survival rates of the three groups of patients were 90%, 84%, and 83%, respectively. Compared with non-smoking patients, patients with past and current smoking have a higher risk of PCa biochemical recurrence. However, quitting smoking for more than 10 years can reduce the risk of biochemical recurrence. In addition, multivariate analysis found no significant correlation between cumulative smoking exposure and the risk of biochemical recurrence. The above results show that smoking status is closely related to biochemical recurrence after PCa radical surgery, and the risk of biochemical recurrence in patients with past and current smoking is almost twice that of non-smoking patients.

The adverse effects of smoking on biochemical recurrence seem to be alleviated when smoking is stopped for more than 10 years. This is a wake-up call for smoking patients to fully understand the impact of smoking on PCa prognosis, and doctors also need to play a broader role in the health management of the smoking population.