title: Smoking and adverse outcomes at radical prostatectomy.
abstract: BACKGROUND
  Multiple large epidemiologic studies have examined the relationship between smoking and prostate cancer incidence and mortality only to arrive at contradictory results. In this series, we studied the effect of smoking on pathologic outcomes and biochemical recurrence in a cohort of men undergoing radical prostatectomy.
  
  
  METHODS
  We identified 630 men who underwent radical prostatectomy between 1989 and 2005 who had detailed smoking histories. There were 321 smokers and 309 nonsmokers. 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 was defined as a postoperative PSA ≥ 0.1 ng/ml. Univariate analysis and multivariate linear and Cox regression were used to study the impact of smoking on these outcomes.
  
  
  RESULTS
  The volume of cancer (2.54 vs. 2.16 ml, P = 0.016) and the volume of high grade cancer (0.58 vs. 0.28 ml, P = 0.004) were greater in smokers compared with nonsmokers. Smoking independently predicted greater volumes of cancer and high grade cancer in multivariate analysis. Heavy smokers (≥20 pack-year history) had a greater risk of biochemical recurrence on univariate survival analysis. Smoking also predicted a greater risk of biochemical recurrence on Cox regression, the magnitude of which was approximately 1% per pack-year smoked.
  
  
  CONCLUSIONS
  Smoking is associated with adverse pathologic features and a higher risk of biochemical recurrence in men undergoing radical prostatectomy. If confirmed by additional studies, smoking history may need to be included into risk assessment models.
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA. tin.ngo@gmail.com
authors.forename: Tin C
authors.initials: TC
authors.lastname: Ngo
authors.forename: J Joy
authors.initials: JJ
authors.lastname: Lee
authors.forename: James D
authors.initials: JD
authors.lastname: Brooks
authors.forename: Rosie
authors.initials: R
authors.lastname: Nolley
authors.forename: Michelle
authors.initials: M
authors.lastname: Ferrari
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Presti
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000503:physiopathology* / Q000601:surgery*; D012008:Recurrence; D012044:Regression Analysis; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen