Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Prostate cancer risks higher in smokers

Foerster B et al. JAMA Oncol. 2018 May 24. doi: 10.1001/jamaoncol.2018.1071.

Key clinical point: Patients with localized prostate cancer should be encouraged to quit smoking because of the risk of potentially worse oncologic outcomes.

Major finding: Current smokers had a higher risk of biochemical recurrence, metastasis, and cancer-specific mortality, with hazard ratios of 1.40, 2.51, and 1.89, respectively.

Study details: A systematic review and meta-analysis of 11 studies involving 22,549 patients with prostate cancer undergoing radical prostatectomy or radiotherapy.

Disclosures: The first author is supported by the Scholarship Foundation of Swiss Urology. One coauthor reported disclosures related to Astellas, Cepheid, Ipsen, Jansen, Lilly, Olympus, Pfizer, Pierre Fabre, Sanochemia, Sanofi, and Wolff.

Source: Foerster B et al. JAMA Oncol. 2018 May 24. doi: 10.1001/jamaoncol.2018.1071.

Read the article.


Foerster B et al. JAMA Oncol. 2018 May 24. doi: 10.1001/jamaoncol.2018.1071.


Prostate cancer–smoking link more clear

While previous studies have linked smoking to adverse outcomes in prostate cancer, including death, this study argues that the higher rate of prostate cancer–related death among smokers is a real effect with a biological cause, Stephen J. Freedland, MD, said in an editorial.

The current study included only men healthy enough to undergo aggressive treatment, which is an “important and necessary step to level the playing field,” Dr. Freedland wrote.

In that context, current smokers in this study had an 89% increased risk of prostate cancer–related death. “This finding shows that when we treat patients equally and minimize deaths from other causes, there is a stronger link between smoking and death from prostate cancer,” Dr. Freedland noted.

The finding also supports the notion that many smokers won’t live long enough to die from prostate cancer, given its slow-growing nature and the effects of smoking on competing causes of death, he added.

A scenario in which smokers did not live long enough to die of prostate cancer would predict a lower risk of prostate cancer–related death among smokers, he explained.

Because smoking has such clear adverse effects, physicians of all specialties should be hypervigilant about urging patients to quit smoking, Dr. Freedland concluded.

“If all of us remembered we are physicians first and oncologists and/or prostate cancer experts second, we will realize we are uniquely poised to help our patients, as the time of a new cancer diagnosis is a teachable moment when patients are very receptive to overall health advice,” he wrote.

Dr. Freedland is with the Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles. These comments are derived from his editorial in JAMA Oncology. Dr. Freeland had no reported conflict of interest disclosures.

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