Smoking May Influence Fatal Prostate Cancer Risk

The study covered in this summary was published in medRxiv as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Older men who smoke may be more likely to develop metastatic and fatal prostate cancer.

Why This Matters

  • In most cases, prostate cancer risk is determined by unmodifiable, inherited traits; however, this study suggests that lifestyle factors — smoking, in particular — can also contribute. A healthy lifestyle may curb the risk of prostate cancer mortality in high-risk men.

Study Design

  • Researchers gathered data from the Department of Veteran Affairs Million Veteran Program, a population-based study with genotyping, long-term follow-up, and linked clinical records for over 870,000 participating US veterans.

  • Overall, 281,923 patients participated (median age, 68 years at enrollment). They completed a questionnaire with nearly 400 in-depth questions on lifestyle factors, including smoking, body mass index (BMI), and exercise.

  • The study accounted for race/ethnicity, family history, and genetic risk.

Key Results

  • Not smoking was independently associated with lower risk of metastatic prostate cancer (hazard ratio [HR], 0.54).

  • Nonsmokers were also at a ower risk of fatal prostate cancer (HR, 0.35).

  • Higher BMI was independently associated with a slightly lower risk of fatal prostate cancer (HR, 0.97)

  • Exercise was associated with lower risk of metastatic disease (HR, 0.74) and fatal disease (HR, 0.74); however, exercise was not independently associated with prostate cancer endpoints on multivariable analysis.


  • Diet was not included in the multivariable analysis.

  • Lifestyle factors were only measured at the time of enrollment in the program, and fluctuations over time were not captured.


  • The study received funding from the Veterans Health Administration, the National Institutes of Health, the National Institute of Aging, the National Institute of Biomedical Imaging and Bioengineering, the Prostate Cancer Foundation, the University of California, the Marxuach Family Fellowship, and the Moores Cancer Center, University of California Health.

This is a summary of a preprint research study, “Healthy Lifestyle and Prostate Cancer Risk in the Million Veteran Program.” The study has not been peer reviewed. The full text can be found at medRxiv.

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