Prostate Cancer

Smoking Tied To More Aggressive Prostate Cancer

Smoking has been associated with multiple risks and health problems.

In many countries, tobacco companies are compelled to include severe warnings and images to their products.

But still, the habit of smoking is prevalent in nearly 40 million people in the U.S. alone. According to the CDC statistics, over $170 billion are spent every year on medical care associated with cigarette smoking.

Most of us have heard the effects of smoking on lung cancer. But what about prostate cancer?

In this article, we’re reviewing the relationship between prostate cancer and smoking. 

What is prostate cancer?

As the name implies, prostate cancer is a type of cancer that grows in the prostate gland. This type of cancer should be differentiated from benign prostatic hyperplasia or BPH.

Both of them feature prostatic enlargement, but BPH is not aggressive and isn’t likely to cause significant problems. On the contrary, prostate cancer has a higher chance of complications.

In most cases, prostate cancer is silent and nonaggressive. It usually grows in older adults, and very slowly. Thus, patients are more likely to die from natural causes as compared to prostate cancer. However, there are exceptions to this rule, and that’s why it is essential to evaluate patients with urinary symptoms.

When it is contained inside the prostate’s capsule, this type of cancer is unlikely to cause symptoms. It is localized and nonaggressive prostate cancer. Thus, at this stage, all we can do is evaluate the risks of patients. When it grows a bit more, patients start having urinary symptoms. They are initially mild, and even though they worsen over the years, patients may fail to notice the difference.

Advanced prostate cancer has a higher risk of spreading to other parts of the body. The first stage of metastasis is to the lymph nodes. Then, prostate cancer cells can travel to the bones and other organs.

At this stage, patients may also start feeling other symptoms, such as bone pain. But even in this stage, it is possible to keep prostate cancer in control. Some patients may live several years in this condition, depending on the type of cancer, its aggressiveness, and the therapeutic measures (1).

Risk factors for prostate cancer

There are several recognized risk factors for prostate cancer. Each one of them increases prostate cancer risk but may not trigger the condition by themselves.

We have modifiable and non-modifiable risk factors. The ones we can’t modify are as follows (2):

  • Older age: According to studies, prostate cancer is more prevalent in the elderly. They have an increased risk, and it is scarce in men under 40 years old. Around two-thirds of the diagnoses of prostate cancer are made in patients over 65 years. According to autopsy studies, 50% of men between 70-80 years had prostate cancer. Since it was not fatal prostate cancer, many of them were not detected or treated.

  • A family history of prostate cancer: Prostate cancer runs in families. It has a hereditary tendency, and some genes have been found as possible causes. These genes are more commonly associated with the androgen receptor in the prostate tissue. Around 10 to 15% of patients diagnosed with prostate cancer have one or more family members with the same problem. The risk is higher if you have a family history in first-degree relatives (parents and brothers). Genetics and environmental factors may both contribute to this higher risk.

  • African American ethnicity: Racial predisposition is a significant risk factor to consider in prostate cancer. The incidence and the risk of mortality rates are higher in patients with an African American ethnicity. The lowest risk can be found in Asian men, and Caucasians are associated with intermediate risk. This is not only due to genetics. It is also due to lifestyle and cultural factors that influence prostate cancer.

  • Hormonal factors: Some hormones have been linked with a higher incidence of prostate cancer. Androgens, in particular, are associated with prostate cancer risk. They are essential for prostate growth, and very high levels can trigger cancer. Similarly, deficient levels of estradiol may also contribute to prostate cancer. Insulin and insulin-like growth factors may also be involved.

On the other hand, there are other risk factors we can change. They are (2):

  • Diet and nutrition: This risk factor is still under research. There’s conflicting evidence, and nothing very clear yet. However, many studies point to alcohol, dairy, red meat, and saturated fat as possible risk factors. Conversely, increasing your consumption of fruits and vegetables appears to reduce the risk. Some studies recommend consuming tomato and other natural sources of lycopene to reduce the risk. Allium vegetables such as onions and garlic may also have antitumor effects. On the contrary, eating high levels of cadmium, copper, iron, and calcium may increase prostate cancer risk.

  • Bodyweight and physical activity: Obesity and overweight increase the risk of prostate cancer. Body Mass Index at the time of prostate cancer diagnosis is also associated with mortality. According to studies, having a BMI higher than 30 leads to a higher risk of high-grade disease. It is also a predictor of biochemical recurrence of prostate cancer after surgery (radical prostatectomy).

  • Vasectomy: This procedure has been linked with an increased risk of prostate cancer. The risk is modestly elevated, not sufficiently elevated to question its use as a contraceptive procedure. More studies should evaluate the association to know the causes and possible solutions.

Smoking and prostate cancer

The association between smoking and prostate cancer is elusive and a current matter of debate. If we analyze prostate cancer incidence, we will find contradicting results.

Some studies claim that smoking status increases the incidence of prostate cancer. Others show that there’s no significant relationship between these variables.

One author offered an explanation. He said that this is maybe because smoking only makes cancer more aggressive. Since most prostate cancer cases are indolent and nonaggressive, the association is difficult to evaluate (3).

The association is clear if we analyze tobacco smoking versus prostate cancer mortality rates. According to studies, patients who smoke have an increase in prostate cancer death risk. The higher incidence is variable, from 9 to 30% increased risk.

Other studies show that the number of cigarettes is also important. The higher risk starts in those who smoke 20 cigarettes every day. However, even previous smokers may sometimes have a higher incidence (4).

Still, these results are a matter of debate. Recent studies show that people who smoke have a lower risk of screening. Smoking is also associated with poor compliance with prostate cancer treatment and biopsies. That may partly explain why smoking patients have a higher-grade disease.

It also explains why patients who smoke do not appear to have a higher incidence of the disease. They probably have an increased risk, but since they do not screen for prostate cancer as instructed, not all are detected (5).

But why is smoking associated with a higher risk of aggressive prostate cancer? There are many possible causes, according to a recent systematic review (6):

  • Inflammation: Smoking causes inflammation, and this is commonly addressed in different situations. Studies show that smokers have a highly inflamed prostate compared to nonsmokers. Chronic inflammation of the prostate increases the concentration of cytokines and other substances. These act as growth factors and trigger the uncontrolled proliferation of the prostate. In these circumstances, the prostate cells are more susceptible to undergo mutations. In patients with cancer, inflammation feeds cancer and makes it more aggressive. It contributes to increasing the blood flow and the adequate conditions for cancer to keep growing.

  • Carcinogenic substances: These substances are commonly found in tobacco products. There is a long list of carcinogenic substances under the group of polycyclic aromatic hydrocarbons. These cause mutations as detected in vitro, and maybe the cause of prostate cancer aggressiveness. Another substance in cigarettes is cadmium. This carcinogenic has been found to influence prostate cancer directly. It interacts with the androgen receptor and stimulated prostate growth. In combination with androgens, it strengthens the effects of DHT in the prostate. Thus, it contributes to prostate cancer.

  • Hormone changes: We can also find some hormonal changes in people who smoke. These individuals have higher concentrations of free testosterone, total testosterone. Moreover, they also have a more elevated total estradiol and free estradiol. The secretion of testosterone and its conversion into estradiol are both affected. What’s more, people who smoke a higher number of cigarettes have greater concentrations of estradiol. According to our current understanding of prostate cancer hormones, testosterone contributes to cancer growth, and estrogen induces more aggressive carcinogenesis.

  • Gene polymorphism mutations: In some individuals, there could be a mutation in genes involved with detoxification. In normal circumstances, carcinogenic substances undergo a detoxification process. For example, they can go through an enzyme called glutathione-S-transferase. These facilitate the removal of the toxic substances and are synthesized in the prostate tissue. Not having these enzymes in the prostate tissue or having a mutation may promote prostate cancer. Other tumor-suppressing genes, such as the p53 gene, may also be involved.

For all of the above, the association between smoking and aggressive prostate cancer is made clear. Prostate cancer incidence remains almost the same. However, this is probably because smokers are less likely to screen for prostate cancer.

On the other hand, smoker prostate cancer patients are more likely to have an aggressive cancer type. They are more likely to die from prostate cancer or have complications. This is because there’s a significant increase in prostate tissue inflammation, the individual is exposed to carcinogenic substances, and hormonal changes favor prostate cancer.

The incidence of aggressive prostate cancer is higher still in patients with a mutation in enzymes that detoxify the organism.

Other side effects of smoking

Similar to prostate cancer, smoking is associated with a myriad of health conditions.

Around 62% of patients with prostate cancer are also current smoking users or recent quitters. In some cases, former smokers. This association is more common in cases of lung cancer and neck cancer. 

Smoking cessation improves the survival rates of these types of cancer. It also reduces the risk of complications and may improve prostate cancer survivors’ quality of life (7).

According to the CDC, these are significant side effects of smoking we should consider:

  • Cardiovascular disease: Smoking causes a 2-fold to 4-fold increase of coronary heart disease and stroke. Even if you consume 5 cigarettes a day or less, you may have earlier cardiovascular disease signs. This is because smoking causes damage to your blood vessels. They become thicker and narrow down the available space for blood. It increases your blood pressure, your heartbeat, and the formation of blood clots.

  • Respiratory disease: Smoking increases the risk of lung cancer 25 times compared to nonsmokers. It also causes COPD, chronic bronchitis, emphysema, and other respiratory diseases. In patients with asthma, smoking can cause an asthma attack or make it worse.

  • Cancer incidence: Besides prostate cancer and lung cancer, smoking can cause or influence many others. We have a higher risk of bladder cancer, colorectal cancer, esophagus cancer, cervix cancer, oropharynx cancers, etc. The risk of dying from cancer is also increased.

  • Fertility problems: According to studies, smoking can affect fertility in men and women. In pregnant women, it is also associated with complications, such as preterm delivery. These women may also have an ectopic pregnancy, low birth weight, stillbirth, and other problems.

  • Bone health problems: Smoking affects your bones, making them weaker. They are thus more susceptible to fractures. Tooth loss is also more common in smokers.

  • Visual problems: Smoking can cause severe visual problems, such as cataracts and age-related macular degeneration.

  • Metabolic problems: Smoking can cause type 2 diabetes and make it harder to control. The risk is 40% higher in smokers. Systemic inflammation is also increased, and the immune function is affected. That’s why it is also associated with rheumatoid arthritis.

Steps to quit

Smoking cessation can lower the risk of most of the side effects mentioned above.

However, it is usually not easy to quit, and we go through uncomfortable withdrawal symptoms. But if you want to quit, you can start considering the following step-by-step guide:

  • Make your decision: It is vital to make your decision and identify strong reasons to quit. Even if you tried to quit before, do it again and convince yourself it is for your own good.

  • Choose a date and make a commitment: It is crucial to prepare your mind. Pick a date and stick to it.

  • Inform people around you: If you have support, it will be easier to quit. Talk to people who will likely support you and tell them how they can help. 

  • Anticipate high-risk situations: Smoking is not only a substance addiction. You’re also psychologically addicted to certain conditions that trigger the urge to smoking. Identify and anticipate these high-risk situations and make a plan for each one of them.

  • Replace the oral sensation: When you’re a smoker, your brain craves the sense of having a cigarette. You can replace that with raw vegetables, gum, hard candies, and other substitutes.

  • Go through the first two weeks: The first two weeks are extremely important. Try to stay busy during these first two weeks and avoid reminders and high-risk situations. Keep your hands busy, find moments to relax, talk to people who offered their help. All of this may help you get through this difficult time.

  • Celebrate your victories: Celebrate every step you take and every success you have. Think of how strong you have been if you ever have cravings. Refuse to let it win. Remind yourself about the reasons for quitting.

Conclusion

Smoking has many health consequences, and one of them is more aggressive prostate cancer. According to studies, smokers apparently have a similar incidence of prostate cancer.

However, they also have lower compliance in prostate cancer screening. This may explain the similarities in prostate cancer incidence in smokers versus nonsmokers. 

However, prostate cancer increases inflammation, exposes the body to carcinogens, and changes the hormone profile. All of these factors influence prostate cancer, making it more aggressive. That’s why prostate cancer mortality and its complications are more prevalent in patients who smoke.

Sources

  1. Heidenreich, A. P. J. B., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., Mason, M. D., … & Zattoni, F. (2012). Guidelines on prostate cancer. European association of urology, 45.
  2. Shah, S. I. A. (2016). An update on the risk factors for prostate cancer. WCRJ, 3(2), e711.
  3. Islami, F., Moreira, D. M., Boffetta, P., & Freedland, S. J. (2014). A systematic review and meta-analysis of tobacco use and prostate cancer mortality and incidence in prospective cohort studies. European urology, 66(6), 1054-1064.
  4. Huncharek, M., Haddock, K. S., Reid, R., & Kupelnick, B. (2010). Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies. American journal of public health, 100(4), 693-701.
  5. Ho, T., Howard, L. E., Vidal, A. C., Gerber, L., Moreira, D., McKeever, M., … & Freedland, S. J. (2014). Smoking and risk of low-and high-grade prostate cancer: results from the REDUCE study. Clinical Cancer Research, 20(20), 5331-5338.
  6. De Nunzio, C., Andriole, G. L., Thompson Jr, I. M., & Freedland, S. J. (2015). Smoking and prostate cancer: a systematic review. European Urology Focus, 1(1), 28-38.
  7. Warren, G. W., Kasza, K. A., Reid, M. E., Cummings, K. M., & Marshall, J. R. (2013). Smoking at diagnosis and survival in cancer patients. International journal of cancer, 132(2), 401-410.

 

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