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Tobacco smoking and death from prostate cancer in US veterans



Cigarette smoking is a risk factor for mortality in several genitourinary cancers, likely due to accumulation of carcinogens in urine. However, in prostate cancer (PC) the link has been less studied. We evaluated differences in prostate cancer-specific mortality (PCSM) between current smokers, past smokers, and never smokers diagnosed with PC.


This was a retrospective cohort study of PCSM in men diagnosed with PC between 2000 and 2015 treated in the US Veterans Affairs health care system, using competing risk regression analyses.


The cohort included 73,668 men (current smokers: 22,608 (30.7%), past smokers: 23,695 (32.1%), and never smokers: 27,365 (37.1%)). Median follow-up was 5.9 years. Current smoker patients were younger at presentation (median age current: 63, never: 66; p < 0.001), and had more advanced disease stage (stage IV disease current: 5.3%, never: 4.3%; p < 0.04). The 10-year incidence of PCSM was 5.2%, 4.8%, and 4.5% for current, past, and never smokers, respectively. On competing risk regression, current smoking was associated with increased PCSM (subdistribution hazard ratio: 1.14, 95% confidence interval: (1.05–1.24), p = 0.002), whereas past smoking was not. Hierarchical regression suggests that this increased risk was partially attributable to tumor characteristics.


Smoking at the time of diagnosis is associated with a higher risk of dying from PC as well as other causes of death. In contrast, past smoking was not associated with PCSM suggesting that smoking may be a modifiable risk factor. PC diagnosis may be an important opportunity to discuss smoking cessation.

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The project described was partially supported by the National Institutes of Health, Grant TL1TR001443 (PR, AKB, AK, RRS). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations



Conception: PR, AK, JM, and BR; Data analysis/acquisition: PR, AK, EL, LK, VN, RS, and AB; Draft writing: PR, AK, and BS; Editing and reviewing: All authors; Approval of final manuscript: all authors.

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Correspondence to Brent S. Rose.

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PR discloses previous salary support from Peptide Logic, LLC. AKB discloses consulting fees from Boston Consulting Group. Reith R. Sarkar discloses consulting fees from Boston Consulting Group. AK discloses consulting fees from and ownership stake in Sympto Health. JDM disclose consulting fees from Boston Consulting Group and ownership stake in Sympto Health. The remaining authors declare that they have no conflict of interest.

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Riviere, P., Kumar, A., Luterstein, E. et al. Tobacco smoking and death from prostate cancer in US veterans. Prostate Cancer Prostatic Dis 23, 252–259 (2020).

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