Two Changeable Risk Factors for Prostate Cancer Death

Hey, wait, come back!  This story sounds grim, but it’s actually hopeful!  There are two things you can do right now that raise your odds of not dying of prostate cancer: Stop smoking, and lose weight.  Both of these can make a big difference.

For several years now, doctors have known that there was a link between prostate cancer and smoking.  They couldn’t prove that smoking caused prostate cancer, but they knew that men who smoke cigarettes – if they developed prostate cancer – were more likely to have aggressive disease, and to die of it.

They know more now.  Scientists led by Johns Hopkins epidemiologist Elizabeth Platz, Sc.D., M.P.H., studied men who had prostatectomy for localized prostate cancer.  Those who continued to smoke after their diagnosis and treatment were more than two times more likely to have their cancer come back than men who never smoked.  But “men who had quit smoking had a similar risk of recurrence as men who never smoked.”

Let’s just stop for a second:  This is really important and hopeful, because it shows that when you quit smoking, your body starts to heal, and your risk of being cured of localized prostate cancer goes way up.

Platz puts it bluntly:  “Smoking is a risk factor for prostate cancer death.  If you start with a group of men who don’t have a diagnosis of prostate cancer, and they smoke, in the future they’re more likely to die of prostate cancer.  Men who have prostate cancer, if they continue to smoke, are more likely to die of prostate cancer.  Men who have been treated for prostate cancer, if they keep smoking, are more likely to die.  Even if they had surgery, the cancer is more likely to recur.”

Platz and other scientists know the connection between smoking and prostate cancer is powerful, but they don’t know exactly why and how smoking makes the body so susceptible to lethal prostate cancer.  “The reason why more is not known about the mechanisms at work here, frankly, is that nobody cares about smoking anymore —even though it accounts for most of the cancers in the United States and it really does explain a chunk of prostate cancer deaths.”   Smoking-related research funding is harder to come by.  “It seems like it’s an old story, so no one wants to talk about it anymore, despite it being so important: Smoking causes premature births, causes lung cancer, causes heart attacks, causes so many bad things.”

In a recent study, Platz and colleagues figured, “we know what’s happening to men who smoke who are followed as part of research studies.  What about larger groups – like entire states – where the prevalence of smoking has gone down?”  Several states have significantly lowered the number of people smoking, through cigarette taxes, indoor air pollution laws, workplace smoking bans, and “quit lines” (smokers call a number and receive many services, often for free, including nicotine patches or gum, counseling sessions, and a lot of help to quit – see below).  The investigators picked four states: Maryland, California, Utah, and Kentucky.  They found that in the states where smoking has decreased, the rate of deaths from prostate cancer has dropped, as well.

The bottom line:  At any point in your life, if you stop smoking, you are less likely to die of prostate cancer.

Note:  It is not clear how the “vape” or e-cigarettes figure in here.  There are a lot of chemicals in these products, and they haven’t been studied for very long, and as far as I know, there are no studies linking e cigarettes and prostate cancer.  That said, they may raise your general risk of getting cancer.

Fat and Prostate Cancer:  Another important risk factor may surprise you:  Obesity.  “Again, it sounds like old news, but we are a fat society,” says Platz.  The thing is, like smoking, obesity is “pretty convincingly associated with being diagnosed with more aggressive disease and death from prostate cancer.  For men who have prostate cancer, being obese and continuing to gain weight is associated with higher disease recurrence and death.”

Why is this?  People who are overweight tend to have higher glucose levels, higher insulin levels, and to produce cytokines – immune system boosters, which can encourage inflammation; sometimes inflammation is good, if it helps you fight off infection, but other times, it can put added stress on the body and perhaps tip the balance toward cancer.  “We need to understand the biology better, and then maybe if we knew the pathways affected, we could come up with ways to intervene directly,” says Platz.  “In the meantime, the better approach is to lose weight, even though it’s hard for many of us to do.”

The good news here is that at every phase of your life – just as with smoking – changing your lifestyle will help you.  If you’re a young man, losing weight might stop the disease from developing.  “If a tumor is already there, but very small, and not yet PSA-detectable, losing weight may delay the growth of cancer.  If you have a diagnosis of cancer, losing weight can slow or help prevent the cancer from growing to form metastases” (from spreading to other sites in the body).

“It’s never too late to lose weight or stop smoking.  If you quit now, or lose weight now, it will benefit you now and in the future.”

            For More Help:  It’s hard to quit smoking, and it’s hard to lose weight.  The good news is that there has never been more help available for both of these challenges.

For smoking: You can call 1-800-QUIT NOW (1-800-784-8669) for help; this is a state “quit line,” and the services offered here are free.  Under the Affordable Care Act, insurance plans must cover some services to help people quit smoking. Depending on your insurance, you may be able to get help for free.  A couple of links you might want to check out are:  Smokefree.gov. and http://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/quit-smoking

For weight loss:  Here, too, under the Affordable Care Act, insurance plans must cover screening and counseling for obesity, and depending on your insurance plan, you might be able to get help for free.  Here’s a link to the government’s website;  http://healthfinder.gov/HealthTopics/Category/health-conditions-and-diseases/diabetes/watch-your-weight#the-basics_1.  It helps to talk to somebody, and don’t worry:  They’re not going to judge you; they are there to help you. Just about every medical center has some type of weight management center.  They wouldn’t have these centers if there weren’t millions of people who need to lose weight.  “Intensive weight loss counseling has been shown to be effective,” says Platz.

Caution:  Beware of any radical or fad diet that offers drastic results very quickly.  Those almost universally fail.  Instead, look for gradual, proven plans.  It’s the Tortoise vs. the Hare approach: Slow and steady wins the race.

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years in our books, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington