Abstract
BACKGROUND: Association of cigarette use with risk of prostate cancer remains unclear. We performed this study to examine whether cigarette use is associated with increased risk of prostate cancer. METHODS: This cross-sectional study used data from the 1999 to 2020 National Health and Nutrition Examination Survey (NHANES), a population-based nationally representative survey designed to assess the health and nutritional status of US adults and children. Males were eligible if they were aged ≥ 20 years at the time of participation. Cigarette use (ever use, categorized into former use and current use) was defined as having smoked at least 100 cigarettes in life. Smoking duration, cigarettes smoked per day, and smoking pack-years were calculated in former smokers and current smokers. The primary outcome was self-reported diagnosis of prostate cancer by participants. Logistic regression was used to calculate the adjusted odd ratios (aOR) and 95% CI for the associations of cigarette use with risk of prostate cancer, adjusting for demographic characteristics. Subgroup analyses by age group were conducted. Data were analyzed from June 4 to November 30, 2023. RESULTS: Of the 107 622 participants in 1999-2020 NHANES, 28 170 were included in the analysis. The mean (SD) age of the 28 170 participants was 46.4 (16.4) years, 68.0% were non-Hispanic White. Compared with never smokers, ever (aOR, 2.41 [95% CI, 1.15-5.06]) and former smokers (aOR, 3.56 [95% CI, 1.62-7.85]) had a higher risk of prostate cancer. This higher risk in former (aOR, 3.82 [95% CI, 1.69-8.64]) and ever smokers (aOR, 2.82 [95% CI, 1.27-6.25]) was also found in participants aged 20-59 years. Dose-response analysis showed a positive association between smoking duration (aOR, 1.07 [95% CI, 1.03-1.11]), cigarettes smoked per day (aOR, 1.03 [95% CI, 1.00-1.07]), smoking pack-years (aOR, 1.02 [95% CI, 1.01-1.03]) and risk of prostate cancer in current smokers. CONCLUSIONS: This study suggests that cigarette use was associated with an increased risk of prostate cancer in US males, especially among those aged 20-59 years. Further research utilizing prospective study design and modeling family history is needed to confirm the findings.