Men who smoke are more likely to have adverse pathology findings and a higher risk that PSA levels will elevate following radical prostatectomy for prostate cancer, according to a new study presented during the 106th Annual Scientific Meeting of the American Urological Association (AUA).

Researchers from the Stanford University School of Medicine, Stanford, CA, identified 630 men with detailed smoking histories who underwent radical prostatectomy between 1989 and 2005. There were 321 smokers and 309 non-smokers in the study. Pathologic outcomes included prostate weight, volume of cancer, volume of high-grade cancer, margin status, seminal vesicle involvement, extraprostatic extension, perineural invasion, angiolymphatic invasion and the presence of nodal metastasis. Biochemical recurrence – a rise in PSA level following radical prostatectomy – was measured at PSA 0.2ng/ml. Various analyses were used to compare the smokers and the non-smokers.

Smokers had higher cancer volume compared to non-smokers (2.54 vs. 2.16 mL, p=0.016) and greater volume of high-grade cancer (0.58 vs. 0.28 mL, p=0.004). Heavy smokers (defined as those with a 20 pack-year history) had a greater risk of biochemical recurrence on univariate survival analysis; smoking also predicted a greater risk of recurrence on Cox regression, with roughly a 1 percent increase in PSA level per pack-year smoked.

"These data indicate that smoking history could provide valuable insight and should be included in risk-assessment models for prostate cancer," said Joseph C. Presti, MD, of the Stanford Cancer Institute. "The study also presents a strong message to men: quitting smoking now could impact your ability to survive prostate cancer later."