Smoking And Prostate Cancer

Cigarette smoke contains hundreds of carcinogenic substances that have demonstrable effects on all phases of cancer devel-opment.14 Tumor initiation, promotion and progression have been associated with compounds found in tobacco smoke in a variety of experimental tumor model systems.15 The well-accepted associations between smoking and neoplasms of the lung, bladder, and head and neck do not necessarily rule out a potential causal association between smoking and prostate cancer. It must be remembered that weaker (but nevertheless causal) associations between a particular agent and a disease may only be apparent with robust investigations and, indeed, may be almost impossible to prove given the limitations of modern epidemiology. From a methodological viewpoint, it is becoming more and more difficult to assess associations between tobacco and cancers as a larger proportion of the population are ex-smokers. Thus, not only is cumulative exposure data potentially important but so are data about smoking cessation and its temporal association with diagnosis. For

Table 22.2. Potential associations between tobacco and prostate cancer incidence or progression: influence of the causation effect.

Mechanism

Incidence

Progression

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