Recurrence of Prostate Cancer in Smokers

Chronic active smoking has long been known as a recognized risk factor in the pathogenesis of several malignant lesions; including but not limited to carcinoma of lungs, gastrointestinal tract, skin cancers, malignancies of genital tract and glands like prostate. Risk factors like smoking are also associated with poor prognosis due to high risk of complications. For example, prostate-related mortality rate is 30% in smokers as compared to males who never smoked.It is imperative to mention that the risk of recurrent malignant lesions is also fairly high in smokers. For example, according to a new study reported in the peer reviewed Journal of American Medical Association (1), investigators suggested that chronic smoking (for more than 10 years) can aggravates the risk of recurrent prostate cancer even after radical prostatectomy.Based on the results of a critical analysis that was conducted on 7191 males during the period of 2000 to 2011, investigators discovered that the risk of recurrence was twice as much in chronic active smokers when compared to non-smokers with a history of prostate malignancy and radical prostatectomy procedure.

Pathogenesis of Recurrent Prostate Malignancy in Prostate Cancer Survivors

Various theories and explanations have been formulated to explain the association of recurrent prostate malignancy in chronic active smokers. For example, it has been suggested that carcinogens present in the cigarette smoke elicits molecular changes in the prostate cells to promote tumorigenesis. However, since these molecular changes are introduced within the tumor clonogens (already mutated cells), the recurrent forms of cancers are even more aggressive and difficult to manage.According to the data reported in the peer reviewed Journal of the National Cancer Institute (2), healthcare providers concluded that the cumulative risk/ incidence of recurrent prostate malignancy in chronic active smokers is 34.3%, former smoker is 14.8% and in individuals who never smoke, the risk of recurrence is 12.1%.Other effects or complications that may explain the association of recurrent prostate malignancy in smokers are:

• Higher risk of early distant metastasis
• Higher risk of mortality associated with prostate cancer
• Hormone refractory prostate cancer that restricts possible treatment options

Based on the results of a study conducted on 5366 men (prospective observational study from 1986 to 2006); it was observed that the total number of deaths in prostate cancer patients exceeded 1630 of which about 32% deaths were a result of direct complications of prostate cancer. Additionally, another 26% deaths were caused by cardiovascular complications; which can be reduced by quitting smoking (3).

How Can You Address This Negative Association?

In the light of latest research and clinical data, it is strongly advised to patients as well as at-risk healthy individuals (such as those with a positive family history of prostate cancer or other malignant lesions) to quit smoking altogether.Additionally, it is also highly recommended to keep up with the follow-up visits in order to detect the malignant lesions as early as possible. Moreover, speak to a dietitian or nutritionist to introduce healthy dietary changes to maintain immunity.To conclude; healthcare providers should make a conscious attempt to provide counseling as well as active help to prostate cancer survivors regarding the detrimental effects of smoking in order to produce desirable effects on the general health of prostate cancer survivors.References:

1. Kenfield, S. A., Stampfer, M. J., Chan, J. M., & Giovannucci, E. (2011). Smoking and prostate cancer survival and recurrence. Jama, 305(24), 2548-2555.
2. Joshu, C. E., Mondul, A. M., Meinhold, C. L., Humphreys, E. B., Han, M., Walsh, P. C., & Platz, E. A. (2011). Cigarette smoking and prostate cancer recurrence after prostatectomy. Journal of the National Cancer Institute, 103(10), 835-838.
3. Kenfield, S. A., Stampfer, M. J., Chan, J. M., & Giovannucci, E. (2011). Smoking and prostate cancer survival and recurrence. Jama, 305(24), 2548-2555.
4. Moreira, D. M., Aronson, W. J., Terris, M. K., Kane, C. J., Amling, C. L., Cooperberg, M. R., ... & Freedland, S. J. (2014). Cigarette smoking is associated with an increased risk of biochemical disease recurrence, metastasis, castration‐resistant prostate cancer, and mortality after radical prostatectomy. Cancer, 120(2), 197-204.