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Published on January 22, 2019

Want a better prostate surgery outcome? Quit smokingWant a better prostate surgery outcome? Quit smoking

Men, here’s another reason to throw away the cigarettes.

Smoking has been tied to an elevated risk of many types of cancer, but it has not generally been associated with prostate cancer. A meta-analysis by Austrian researchers published recently in JAMA Oncology challenges that assumption.

The researchers looked at 11 studies of 22,000 prostate cancer surgical patients and compared smokers and non-smokers. They found smokers were 89 percent more likely to die of the disease, 151 percent more likely to have the cancer spread, and 40 percent more likely to have an elevated PSA level following surgery.

Hyannis urologist Jose M. Reyes, MD, of Urology Associates of Cape Cod, said smokers generally do not recover from surgery as well as non-smokers. So, “it’s not surprising” that the study found the same issue with prostate cancer surgery, he said.

The Journal of the American College of Surgeons reported in 2012 that, since 1944, more than 300 studies have found smoking causes many types of surgical complications, such as cardiovascular, pulmonary and wound healing, as well as increased infections, longer hospital stays and a greater need for repeat surgery. A 2017 Chinese study published in Oncotarget reported that smoking decreases the immune system’s defenses while also raising autoimmune responses.

Smoking also makes giving anesthesia for surgery more problematic, and smokers have a greater chance of surgical wounds opening after coughing, according to Dr. Reyes.

A New Approach

The Austrian research may mean urologists need to change how they monitor prostate cancer surgical patients, and keep a closer eye on smokers, he said.

According to the Prostate Cancer Foundation, because prostate cancer typically grows more slowly than many other forms of cancer, and the risk of death within five years of diagnosis is low, doctors often employ “watchful waiting” or “active surveillance”  in low-risk patients or patients who have other conditions, such as heart disease or diabetes. With active surveillance patients receive regular PSA testing, physical exams and occasional biopsies to keep track of the cancer, rather than immediately choosing radiation therapy, hormone therapy or surgery.

Dr. Reyes said his typical prostate cancer patient is in his 60s. Other health problems that complicate treatment are more common among older men, he said.

“On the Cape, we see a lot of patients with multiple issues,” he said.

Younger patients in their 40s and 50s recover better, he added, but they also can have more rapid progression of cancer.

Prostate Cancer Facts

According to the American Cancer Society:

  • Prostate cancer is the second leading cause of cancer death in American men, behind lung cancer. One in 41 men will die of prostate cancer.
  • Each year, 175,000 new cases are diagnosed, and 31,600 men die from it. Prostate cancer does not kill most men diagnosed with it.
  • One in nine men will be diagnosed with the disease during his life.
  • 60 percent of cases are in men 65 or older.

Smoking is closely associated with bladder and kidney cancer, according to Dr. Reyes, and he estimated about half of his patients with those conditions are smokers. Perhaps 10-15 percent of his prostate cancer patients are smokers, he said.

“I am seeing a lot less patients who smoke,” he said. “A lot are quitting.”