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• W2021798793 abstract "In their systematic review, Islami et al [1] performed an extensive search of the literature on the association between smoking and prostate cancer incidence and death [1]. We compliment the authors on their thorough work. Without doubt, smoking is associated with moderately increased mortality. The authors have analysed and discussed this in detail. Less detailed attention was given to the finding that the incidence of prostate cancer in smokers was higher in the era before prostate-specific antigen (PSA), and lower in the post-PSA era. The only explanation suggested by the authors is that smoking may reduce the risk of indolent nonaggressive cancers that have predominated in more recent years, while promoting more aggressive cancers. We believe that another, more important, factor may account for these differences. It could well be that this contrast between the preand post-PSA eras illustrates an important difference associated with lifestyle and the availability of health care services. In the pre-PSA era, themajority of prostate cancers found were clinically relevant, and the majority of prostate cancer patients would have had a disease burden. Smoking may have altered the clinical progression of prostate cancer, resulting in a higher number of clinical diagnoses. By contrast, in the post-PSA era, the vast majority of prostate cancers are diagnosed in men who have been screened. Health literacy and the availability of screening options may be worse for those living an unhealthier lifestyle, such as smokingmen. Rolison et al [2] showed that smoking men were indeed less likely to undergo prostate cancer screening compared to former smokers and nonsmokers [2]. All the current guidelines on prostate cancer diagnosis advocate shared decision-making before a PSA test is performed.We agreewith this need, but we also realise that such shared decision-making may be easier with wellinformed men who generally having a healthier lifestyle. We should be aware that smoking men—who apparently have a worse outcome after initial diagnosis—may have poorer access to health services. Thus, those who might benefit the most are less likely to ask for physician opinions, for example in early diagnosis of prostate cancer.We believe that this deserves our attention, as we are physicians for all of our patients, not just wellinformed healthy patients, in our practices." @default.
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• W2021798793 date "2015-07-01" @default.
• W2021798793 modified "2023-09-27" @default.
• W2021798793 title "Re: Farhad Islami, Daniel M. Moreira, Paolo Boffetta, Stephen J. Freedland. A Systematic Review and Meta-analysis of Tobacco Use and Prostate Cancer Mortality and Incidence in Prospective Cohort Studies. Eur Urol 2014;66:1054–64" @default.
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• W2021798793 doi "https://doi.org/10.1016/j.eururo.2015.01.023" @default.
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