Sperling Prostate Center

Smoking Lowers Your Prostate Cancer Survival Odds

UPDATE: 3/30/2023
Originally published 12/6/2015

In 2018, Reuters Healthcare & Pharma reported, “Prostate cancer patients who smoke are more likely to have tumors return, spread to other parts of the body, and become fatal than nonsmokers, a new study suggests.”

The study in question by Foerster, et al. reviewed 27 journal articles involving a total of 22,549 PCa patients, of which 4202 (18.6%) were current smokers.[i] The analysis also included former smokers and those who had never smoked.

The authors point out that in addition to lung cancer, smoking is implicated in genitourinary cancers, including cancer of the bladder and kidney. They go so far as to say that the link between cigarette smoking and PCa is “robust.”

Statistical analysis revealed that current smokers were 40% more likely to have their PCa recurrence after treatment, more than twice as likely to have cancer spread beyond the gland (metastasis), and 89% more likely to die from their cancer.

A commentator helps us understand why this happens: “…the fact that prostate cancer death is linked with smoking means (these cancer causing) chemicals are not just present in the lungs but absorbed in the body and make their way to the prostate and, as such, they probably make their way into every organ in our body.”[ii]

Finally, a more recent study (2020) calculated smokers’ risk of PCa-specific mortality based on 73,668 cases in Veterans Affairs records, 22,608 (30.7%) of whom were current smokers.[iii] Compared with past smokers and nonsmokers, PCa patients who currently smoked had a higher risk of dying from their PCa as well as other cancers.

The moral of the story is, if you’re a smoker and you’re diagnosed with PCa, quit cigarettes immediately in order to raise your chances of outliving your cancer.


I have written about several health choices that can affect prostate cancer (PCa) outcomes: diet and nutrition, supplements, exercise, caffeine and exercise. In this blog, I want to share the results of a recent Italian study on how smoking affects long term PCa survival. It’s pretty much like a skull-and-crossbones on a bottle of poison.

The authors used case records of 780 PCa patients who were enrolled from 1995-2002 and followed for an average of 13 years.[iv] During the years of follow up, 263 men died. Most of them (182) died of other causes than prostate cancer. However, 81 of them (30%) died from their prostate cancer. How did smoking play a part?

Well, those who had never been smokers at the time of their PCa diagnosis had lower all-cause and prostate cancer specific death rates. However, smoking was a definite mortality risk factor for all causes and for PCa deaths. What’s interesting is that death risk increased as the number of daily cigarettes grew and as the number of years lengthened. Furthermore, the effects of increased smoking were also correlated with higher Gleason scores, meaning more aggressive disease. However, those who were smokers at the time of diagnosis had increased risk of dying from PCa regardless of their Gleason score. There was good news for those who had quit smoking before they were diagnosed, as their increase risk of PCa-related death was not statistically higher than for those who had never smoked.

Everyone knows that smoking can cause lung cancer, but most people are not aware that smoking harms nearly every organ—including the prostate—and affects the general health of smokers. It happens that I’m writing this on Veterans Day (Nov. 11) and I found this chilling statistic from the U.S. Centers for Disease Control and Prevention (CDC): “More than 10 times as many U.S. citizens have died prematurely from cigarette smoking than have died in all the wars fought by the United States during its history.”

It can be difficult for a smoker to quit. Nicotine is a recognized addictive substance because the good feelings it creates make a person want to smoke more, and more often. Smokers go through withdrawal and cravings when they quit. As hard as it might be, the sooner a smoker ends his/her relationship with cigarettes, the more time that person adds to their life. There are many excellent stop-smoking programs and resources. If you are a smoker and are at risk for PCa, or if you have the disease, I encourage you to do whatever you need to do to put those cigarettes down once and for all. It’s in the best interest of your prostate, all your other organs, and your total health.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Foerster B, Pozo C, Abufaraj M, et al. Association of Smoking Status With Recurrence, Metastasis, and Mortality Among Patients With Localized Prostate Cancer Undergoing Prostatectomy or Radiotherapy: A Systematic Review and Meta-analysis. JAMA Oncol. 2018;4(7):953–961.
[ii] Rapaport, Lisa. “Prostate Cancer Survival Odds Worse for Smokers.” Reuters Health, June 5, 2018.
[iii] Riviere P, Kumar A, Luterstein E, Vitzthum LK et al. Tobacco smoking and death from prostate cancer in US veterans. Prostate Cancer Prostatic Dis. 2020 Jun;23(2):252-259.
[iv] Polesel J, Gini A, Dal Maso L, Stocco C et al. The negative impact of tobacco smoking on survival after prostate cancer diagnosis. Cancer Causes Control. 2015 Sep;26(9):1299-305.


About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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