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Don’t let your chance of beating prostate cancer go up in smoke

Don’t let your chance of beating prostate cancer go up in smoke

Updated: 12/21/2015

If you already know how smoking cigarettes damages your health, it shouldn’t surprise you that smoking contributes to prostate cancer — and in ways that scientists are just beginning to understand. Men who stop smoking before they are diagnosed with prostate cancer may be able to slow the development of the disease.

Smoking weakens natural cancer-fighting abilities

At the very least, smoking makes prostate cancer worse. It’s well known that each puff of a cigarette injects nicotine and a toxic chemical cocktail into every cell of the body. So even if smoking didn't cause prostate cancer directly, it probably didn't help prevent it.

Therefore, patients who smoke are more likely to die from their prostate cancer than those who don't smoke. According to, cigarettes weaken your ability to fight off daily damage to your DNA, leaving you unprotected and unable to prevent cancer from developing.

The Prostate Cancer Foundation reports that the more you smoke, the greater your chances of being diagnosed with a more aggressive cancer. The organization also found that patients who smoke are more likely to experience cancer recurrence than nonsmokers.

Study Examines Connection Between Young Smokers and Aggressive Prostate Cancer

Researchers at Johns Hopkins Medicine organized a study of younger men with prostate cancer. Led by Patrick C. Walsh, M.D., William Roberts, M.D., and Elizabeth Platz, Sc.D., M.P.H., the study confirmed that the more you smoke, the greater your chances of being diagnosed with cancer that is more aggressive and that has already spread beyond the prostate. The relationship is dose-dependent, meaning that each cigarette increases your risk a little bit.

The exciting news is that the opposite is also true. If you stop smoking before you are diagnosed with prostate cancer, you may slow the development of the disease or end up with a less aggressive form of it.

Focusing on Younger Prostate Cancer Patients

The scientists focused on younger men for this study since prostate cancer is so rare in this demographic. In fact, aggressive prostate cancer is virtually nonexistent in patients under the age of 40. With age, however, the chance of developing prostate cancer increases. Nearly two thirds of all prostate cancers are diagnosed in men over the age of 65, and nearly one half of prostate cancer deaths occur in men initially diagnosed over the age of 75. Researchers have been very interested in finding out why they get prostate cancer and how cigarette smoking affects them.

Thanks to previous research at Johns Hopkins Medicine, scientists know that patients with a family history of prostate cancer are more likely to develop the disease at a younger age. But until this study, no other risk factors appeared as obvious warnings for cancer in younger men. The researchers wanted to find out whether young men who smoked were more likely to have an aggressive disease.

Between 1992 and 1999, Dr. Walsh performed radical prostatectomy procedures on 1,544 consecutive patients. About one third of these patients were under the age of 55 at the time of surgery. The researchers sent a detailed questionnaire to these patients, asking them about a variety of aspects of their life. Then the researchers divided them into two groups: men with aggressive, high-grade disease (with a Gleason score of 7 or greater), whose cancer had spread beyond the prostate, and men who did not have aggressive disease.

Smoking remains a significant risk factor

In comparing these two groups, the scientists identified cigarette smoking as the most significant risk factor for prostate cancer. The patients who smoked cigarettes were more likely to have more aggressive disease than nonsmokers. And the patients who smoked more cigarettes in the 10 years before their surgery had an increased risk of high-grade disease that quickly spread beyond the prostate. The men who smoked the most (more than 40 pack-years, which could mean two packs a day for 20 years, one pack a day for 40 years, etc.) had greater than three times the risk of high-grade cancer or more advanced disease. The risks were highest for men who still smoked and lower for former smokers.

So why are patients who smoke at high risk of developing the worst kind of prostate cancer and of dying from it because they're diagnosed when the disease has already advanced? One possibility might be that men who smoke are, in general, less concerned about their health, less likely to have regular check-ups and less likely to have their health problems discovered early. But scientists at the James Buchanan Brady Urological Institute don’t believe this is the case.

Smoking and Oxidative Damage

According to Dr. Walsh, cigarette smoking affects prostate cancer cells directly, resulting in aggressive tumor behavior. Oxidative damage provides the key to understanding this outcome. In oxidative damage, cells are injured by free radicals. Normally, free radicals are useful to the body since they help fight bacteria and other foreign invaders.

The body makes substances that are able to control free radicals and limit their damage. The most important of these substances is an enzyme called glutathione S-transferase Pi 1 (GSTP1), which provides toxic cleanup in cells. If cancer is a disastrous chain reaction, one genetic mutation that leads to another, then the decrease in GSTP1 enzymes is probably among the very earliest events.

Cigarettes are known to contain many cancer-causing chemicals. One of the worst of these carcinogens is benzopyrene. According to Dr. Walsh, benzopyrene is also detoxified by GSTP enzymes. So when you start developing prostate cancer and losing GSTP1, you are more vulnerable to oxidative damage and more susceptible to the benzopyrene carcinogens produced by cigarette smoking.


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