Smoking and Prostate Cancer: Why Lighting Up Could Make the Disease Deadlier

Unlike many cancers, prostate cancer often grows slowly, sometimes so gradually that men live long, full lives without it ever becoming life-threatening. But smoking, it turns out, could flip the script making the disease far more aggressive, more likely to spread, and more deadly.

The Research That Raised Alarm Bells

Back in 2014, a large meta-analysis combining data from 51 studies involving more than four million men revealed that smokers had a 24% higher risk of dying from prostate cancer than nonsmokers. But the findings raised a thorny question: were those men dying of prostate cancer itself, or were they dying prematurely from smoking-related killers like heart disease before prostate cancer had a chance to emerge?

An Austrian research team set out to untangle that mystery in a 2018 study. Their approach was sharp and focused: instead of comparing the general public, they zeroed in on 22,000 men who had all undergone surgery for prostate cancer but were otherwise healthy. By doing so, they removed the statistical “noise” of other smoking-related diseases.

Over six years of follow-up, the data painted a stark picture:

Smokers were 89% more likely to die of prostate cancer than nonsmokers.

Their cancers were 151% more likely to spread to other parts of the body.

They faced a 40% higher chance of recurrence, as signaled by rising prostate-specific antigen (PSA) levels after surgery.

The conclusion? For men with prostate cancer, smoking wasn’t just a bad habit it was a dangerous accelerant.

Why Might Smoking Fuel Prostate Cancer?

Here’s the tricky part: the biological link isn’t yet fully clear. Scientists suspect several culprits:

Toxins in cigarette smoke pass through the urinary tract, bathing the prostate in carcinogens.

Smoking may fuel toxic inflammation, creating a breeding ground for tumors.

Or it could be that smoking goes hand-in-hand with other risky lifestyle choices like too little exercise or too much alcohol which worsen outcomes.

Whatever the mechanism, the result is undeniable: smoking makes prostate cancer more aggressive and more deadly.

A Doctor’s Candid Take

Dr. Marc Garnick, professor of medicine at Harvard Medical School and editor-in-chief of HarvardProstateKnowledge.org, has seen this contradiction up close. He finds it baffling that many prostate cancer patients eagerly ask about diets and supplements, most of which have little to no proven benefit while continuing to smoke.

His message is blunt:

“If you have prostate cancer and are concerned about how you can modify the risk for cancer progression, and you are a smoker simply STOP.”

The Bottom Line

Prostate cancer is often thought of as a “slow” disease, but smoking changes the odds in a way that no man should ignore. If you’re already battling prostate cancer, quitting smoking isn’t just about protecting your lungs or heart it’s about giving yourself a fighting chance against the disease itself.

And if you’ve never lit up? Consider this yet another reason to keep it that way. Sometimes the most powerful medicine is not what you add to your life but what you let go of.