BJC Open article

British Journal of Cancer (2013) 108, 708–714. doi:10.1038/bjc.2012.520 www.bjcancer.com
Published online 20 November 2012

Smoking and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition

S Rohrmann1,2, J Linseisen2,3, N Allen4, H B Bueno-de-Mesquita5,6, N F Johnsen7, A Tjønneland7, K Overvad8, R Kaaks2, B Teucher2, H Boeing9, T Pischon9,10, P Lagiou11,12,13, A Trichopoulou11,14, D Trichopoulos12,13, D Palli15, Vittorio Krogh16, R Tumino17, F Ricceri18, M V Argüelles Suárez19, A Agudo20, M-J Sánchez21,22, M-D Chirlaque22,23, A Barricarte22,24, N Larrañaga22,25, H Boshuizen5,26, H J van Kranen5, P Stattin27,28, M Johansson27,29, A Bjartell30, D Ulmert30, K-T Khaw31, N J Wareham32, Pietro Ferrari29, I Romieux29, M J R Gunter33, Elio Riboli33 and T J Key4

  1. 1Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich 8001, Switzerland
  2. 2Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
  3. 3Institute of Epidemiology I, Helmholtz Center Munich, Neuherberg, Germany
  4. 4Cancer Epidemiology Unit, University of Oxford, Oxford, UK
  5. 5National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  6. 6Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
  7. 7Diet, Cancer and Health, Danish Cancer Society, Copenhagen, Denmark
  8. 8Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
  9. 9Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
  10. 10Molecular Epidemiology Group, Max Delbrueck Center for Molecular Medicine (MDC), Berlin-Buch, Germany
  11. 11Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition Policies, University of Athens Medical School, Athens, Greece
  12. 12Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
  13. 13Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
  14. 14Hellenic Health Foundation, Athens, Greece
  15. 15Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
  16. 16Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
  17. 17Cancer Registry and Histopathology Unit, ‘Civile MP Arezzo’ Hospital, Ragusa, Italy
  18. 18Human Genetics Foundation (HuGeF), Turin, Italy
  19. 19Public Health Directorate, Asturias, Spain
  20. 20Unit of Nutrition, Environment and Cancer (UNEC), Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain
  21. 21Andalusian School of Public Health, Granada, Spain
  22. 22Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP), Pamplona, Spain
  23. 23Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
  24. 24Navarre Public Health Institute, Pamplona, Spain
  25. 25Public Health Department of Gipuzkoa, Basque Government, San Sebastian, Spain
  26. 26Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
  27. 27Department of Surgery and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
  28. 28Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  29. 29International Agency for Research on Cancer, Lyon, France
  30. 30Department of Urology, Skåne University Hospital, Malmö, Sweden
  31. 31Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
  32. 32Medical Research Council (MRC) Epidemiology Unit, Cambridge, UK
  33. 33School of Public Health, Imperial College London, London, UK

Correspondence: Dr S Rohrmann, E-mail sabine.rohrmann@ifspm.uzh.ch

Received 13 April 2012; Revised 23 October 2012; Accepted 29 October 2012
Advance online publication 20 November 2012





Smoking is not associated with prostate cancer incidence in most studies, but associations between smoking and fatal prostate cancer have been reported.



During 1992 and 2000, lifestyle information was assessed via questionnaires and personal interview in a cohort of 145112 European men. Until 2009, 4623 incident cases of prostate cancer were identified, including 1517 cases of low-grade, 396 cases of high grade, 1516 cases of localised, 808 cases of advanced disease, and 432 fatal cases. Multivariable Cox proportional hazards regression models were used to examine the association of smoking status, smoking intensity, and smoking duration with the risk of incident and fatal prostate cancer.



Compared with never smokers, current smokers had a reduced risk of prostate cancer (RR=0.90, 95% CI: 0.83–0.97), which was statistically significant for localised and low-grade disease, but not for advanced or high-grade disease. In contrast, heavy smokers (25+ cigarettes per day) and men who had smoked for a long time (40+ years) had a higher risk of prostate cancer death (RR=1.81, 95% CI: 1.11–2.93; RR=1.38, 95% CI: 1.01–1.87, respectively).



The observation of an increased prostate cancer mortality among heavy smokers confirms the results of previous prospective studies.


smoking; prostate cancer; cohort study; EPIC