title: Prognostic importance of tobacco use in men receiving definitive prostate brachytherapy.
abstract: OBJECTIVE
  Several prominent publications have identified an overall association between tobacco use and an increased risk of disease recurrence and disease-specific mortality in prostate cancer patients. The authors explored whether tobacco use adversely impacts treatment outcomes in men treated with permanent interstitial brachytherapy.
  
  
  METHODS
  From April 1995 to August 2008, 2057 patients underwent brachytherapy by a single brachytherapist. Median follow-up was 7.5 years. The role of tobacco use as a prognostic factor for biochemical progression-free survival, cause-specific survival, and overall survival was investigated. Differences in survival between smokers and nonsmokers were compared using Kaplan-Meier curves and log-rank tests.
  
  
  RESULTS
  Current smokers presented with a lower body mass index (p<0.001), smaller prostate size (p=0.003), younger age (p<0.001), higher prostate-specific antigen level (p=0.002), a trend toward higher percentage biopsy core involvement (p=0.08), higher incidence of perineural invasion (p=0.015), and higher risk disease (p<0.001) than former or nonsmokers. There was no difference in biochemical progression-free survival (p=0.30) or cause-specific survival (p=0.72) at 10 years for smokers compared with nonsmokers. On univariate and multivariate analysis, tobacco use was an adverse risk factor for overall survival (p<0.001). There was no association between smoking and any prostate cancer-specific outcome.
  
  
  CONCLUSIONS
  Smokers treated with brachytherapy have excellent outcomes and are at no higher risk of treatment failure than men who are nonsmokers.
authors.affiliation: Department of Radiation Oncology, Western Radiation Oncology, Mountain View, CA, USA.
authors.forename: Al V
authors.initials: AV
authors.lastname: Taira
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Merrick
authors.forename: Robert W
authors.initials: RW
authors.lastname: Galbreath
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Butler
authors.forename: Abbey
authors.initials: A
authors.lastname: Bennett
authors.forename: Edward
authors.initials: E
authors.lastname: Adamovich
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lief
authors.forename: Kent E
authors.initials: KE
authors.lastname: Wallner
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000401:mortality*; D015897:Comorbidity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D012307:Risk Factors; D012907:Smoking / Q000401:mortality*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology