Cigarette smoking and prostate cancer: A systematic review and meta-analysis of prospective cohort studies

INTRODUCTION Cigarette smoking is a well-known cancer-causing behavior and a leading cause of death from cancer. However, according to previously published research and meta-analyses, cigarette smoking has a significant inverse association with prostate cancer incidence. Therefore, this study aims to investigate this association based on updated evidence by conducting a systematic review and meta-analysis. METHODS A search for relevant articles was performed in PubMed and Scopus databases to obtain the pooled relative risk (RR) and the corresponding 95% confidence intervals (CIs) for the risk of prostate cancer incidence among smokers compared to non-smokers. Our search was limited to prospective cohort studies. RESULTS A total of 17 cohort studies were included in the systematic review. Fifteen studies were included in the meta-analysis and showed that cigarette smoking has an inverse association with prostate cancer incidence with a relative risk of 0.84 (95% CI: 0.78-0.91). From all cohorts included in this systematic review, five studies examined the association between current smokers and the risk of death from prostate cancer. Therefore, a meta-analysis of these cohort studies was performed and showed that current smokers had a 42% higher risk of death from prostate cancer when compared to non-smokers with a relative risk of 1.42 (95% CI: 1.20-1.68). CONCLUSIONS Data from observational studies suggest that cigarette smoking has an inverse association with prostate cancer incidence. However, smokers have an increased risk of death from prostate cancer. Important to realize that this lower risk for smokers might be attributed to low prostate cancer screening uptake among smokers, misclassification bias, or selection bias from the included original studies. In summary, our results indicate that the incidence of prostate cancer is lower among smokers. Nevertheless, smokers who develop the disease have a significantly worse prognosis.