If you have been pondering about quitting smoking for some time, the time to act is now. Besides elevating the risk of heart and lung disease, as well as cancers of the bladder and kidney, smoking also raises the odds for developing aggressive prostate cancer that metastasizes, according to recent research.

Studies have also revealed that prostate cancer patients who smoke are at an 89% higher risk of death from the disease than non-smokers. Moreover, the risk of metastasis in smoker patients is 151% higher and there was a 40% greater chance that their prostate-specific antigen levels would spike again post-surgery, indicating a relapse of the cancer.

Smoking raises risk of prostate cancer

As per a review conducted in 2023, cigarettes contain at least 70 potentially cancer-causing substances, including polycyclic aromatic hydrocarbons (PAHs) and cadmium. This means that:

Alterations to the genes that help metabolise and detoxify PAH from the body might elevate the risk of prostate cancer.

Cadmium affects and mirrors the activity of androgens, which are sex hormones.

An elevated level of androgens is associated with an increased risk of prostate cancer.

Another review suggests that smoking at the time of prostate cancer diagnosis could increase the risk of recurrence, death specifically from cancer and overall mortality. Nicotine is also associated with inflammation of the prostate which can trigger negative effects on the prognosis of any person with prostate cancer.

A look at mechanisms of impact

Oxidative damage & free radicals: Smoking releases free radicals into the body, which can cause harm to cell components like lipids, proteins and DNA caused by an excess of free radicals.

Exposure to carcinogens: Tobacco smoke has carcinogens which raise the risk of prostate cancer and negatively impact hormone levels.

Inflammation: Smoking is known to alter cytokine levels, leading to inflammation of the prostate, a key factor in development and progression of prostate cancer.

Impact on prostate cancer

More aggressive & advanced disease: Smokers are often diagnosed with an aggressive and advanced form of prostate cancer.

Rise in mortality rate: Smoking is associated with a greater risk of death from prostate cancer, even as mortality rates rise with the duration and intensity of smoking.

Increased chances of recurrence: Smokers also run a high risk of prostate cancer recurrence following therapy.

Things to consider

Screening bias: The so-called lower incidence of prostate cancer in smokers could very well be due to lower screening rates (like PSA testing) among smokers, and not really due to a true protective effect.

Modifiable risk factor: Kicking the habit of smoking is an effective, modifiable risk factor that can improve survival outcomes in men with prostate cancer.