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Supplementary Table 1A. Characteristics of the 48 studies included in meta-analysis
No.
1
First
author,
publication
year
Hammond,
1958 38
2
Hammond,
1966 39
3
Severson,
1989 42
4
Thompson,
1989 44
5
Mills, 1989
43
6
Akiba, 1990
45
7
Hsing, 1990
46
8
Hsing, 1991
47
Study name (or
description);
country,
recruitment period
American Cancer
Society cohort; USA,
1952
Cancer Prevention
Study I; USA, 19591960
Men of Japanese
ancestry in Hawaii;
USA, 1965-1968
Rancho Bernardo,
California; USA,
1972-1974
Study
design,
outcome
Total
no.
men/
cases b
187783/
185
Smoking
category*
No.
cases*
RR (95% CI)*
Variables the results were adjusted for;
Other comments
Cohort,
mortality
Last
FU
(FU a,
yrs.)
1955
(NR)
Never-smoker
Ever
60
77
Referent
1.57 (1.39-2.17)
Age
Cohort,
mortality
1963
(NR)
440558/
343
Never-smoker
Ever
152
191
Referent
1.13 (0.74-1.52)
Cohort,
incidence
1986
(NR)
8006/
174
Cohort,
incidence
1987
(NR)
1776/ 54
Never-smoker
Ever
Current
Not-smoker
Smoker
63
111
65
43
11
Referent
0.88 (0.65-1.11)
0.87 (0.61-1.23)
Referent
1.3 (0.70-2.5)
Age;
Adjusted RRs but no 95% CIs (we calculated 95%
CIs)
Age
Adventist Health
Study; USA, 1976
Cohort,
incidence
1982
(NR)
35000/
172
Never-smoker
Ever
Current
90
82
3
Referent
1.07 (0.74-1.41)
0.49 (0.16-1.57)
Six-Prefecture
Cohort Study; Japan,
1965
Cohort,
mortality
1981
(16)
122261/
147
Lutheran
Brotherhood
Cohort; USA, 1966
Cohort,
mortality
1986
(20)
17633/
137
US veterans; USA,
1954-1957
Cohort,
mortality
1980
(NR)
248046/
4607
Never-smoker
Current
1-4 Cig/day
5-14
15-24
25-34
35+
Never-smoker
Ever
Current
1-19 Cig/day
20-29
30+
Never-smoker
Ever
39
108
8
50
42
3
5
52
91
26
12
11
3
1075
1864
Referent
1.1 (0.7-1.5)
3.1 (1.4-6.4)
1.0 (0.7-1.6)
0.9 (0.6-1.4)
0.8 (0.2-2.1)
3.0 (1.0-7.1)
Referent
1.8 (1.1-2.9)
1.6 (1.0-2.6)
1.6 (0.8-3.3)
1.7 (0.8-3.5)
1.4 (0.4-4.4)
Referent
1.16 (1.10-1.22)
Age, whole milk and egg intake, BMI, diabetes,
heart disease, cholesterol;
Prevalent cases were also reported. Only incident
cases were considered for this analysis. 90% CIs
were reported for the associations; we converted
them to 95% CIs
Age;
Part of information was obtained from: Mills PK,
Beeson WL. Re: "Tobacco use and prostate
cancer: 26-year follow-up of US veterans". Am J
Epidemiol 1992;135:326-7.
Age, observation period, prefecture of residence,
occupation
Age
Age
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Study
design,
outcome
Last
FU
(FU a,
yrs.)
Total
no.
men/
cases b
9
Tverdal,
1993 48
Norway, five areas;
Norway, 1972-1978
Cohort,
mortality
1988
(13.3)
44290/
32
10
Hiatt, 1994
Kaiser Permanente
Medical Care
Program; USA,
1978-1985
Cohort,
incidence
1985
(NR)
43432/
238
Hawaii State
Department of
Health cohort; USA,
1975-1980
Cohort,
incidence
1989
(NR)
20316/
198
49
11
12
Le
Marchand,
1994 50
Adami, 1996
53
Swedish
Construction
workers; Sweden,
1971-1975
Cohort,
incidence
1991
(18)
135006/
2368
Smoking
category*
No.
cases*
RR (95% CI)*
Current
1-9 Cig/day
10-20
21-39
40+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
20+
Never-smoker
Ever
Current
1-19 Cig/day
20+
Non-smoker
Ever
1-10 Cig/day
11-20
21+
Cumulative use
1-22 pk-yr
23-44
45+
Never-smoker
Ever
Duration
1-10 years
11-20
21-30
31-40
41+
Current
Non-smoker
1-4 Cig/day
5-14
1047
260
695
374
78
4
23
15
7
5
3
79
143
49
24
25
NR
NR
NR
NR
NR
1.18 (1.09-1.28)
1.11 (0.97-1.28)
1.15 (1.05-1.27)
1.23 (1.09-1.38)
1.51 (1.20-1.90)
Referent
1.85 (0.71-7.78)
1.92 (0.61-7.96)
3.95 (1.01-18.42)
1.18 (0.25-5.93)
1.69 (0.25-10.00)
Referent
1.1 (0.9-1.4)
1.2 (0.8-1.6)
1.0 (0.6-1.6)
1.9 (1.2-3.1)
Referent
1.0 (0.7-1.2)
0.9 (0.6-1.4)
1.0 (0.7-1.6)
1.0 (0.6-1.6)
NR
NR
NR
682
1686
0.9 (0.5-1.5)
0.7 (0.4-1.2)
1.2 (0.8-1.8)
Referent
1.10 (1.02-1.18)
19
92
255
454
228
1069
1348
282
459
0.58 (0.43-1.07)
1.27 (1.02-1.58)
1.09 (0.94-1.26)
1.13 (1.01-1.28)
1.07 (0.92-1.25)
1.11 (1.01-1.23)
Referent
1.06 (0.93-1.20)
1.10 (0.99-1.22)
Variables the results were adjusted for;
Other comments
Age
Age, race, education, alcohol intake;
Retrospective cohort using insurance records
Age, ethnicity, income;
Results were reported by quartiles. The
interquartile range for cigarettes/day and pack-yrs.
were reported as 0-20 and 0-44, respectively. We
considered following categories: 0, 1-10, 11-20,
and ≥20 cigarettes/day and 0, 1-22, 23-44, and
≥45 pack-yrs.
Age;
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Study
design,
outcome
Cohort,
mortality
Last
FU
(FU a,
yrs.)
1991
(18)
Total
no.
men/
cases b
135006/
709
13
Coughlin,
1996 54
Multiple Risk Factor
Intervention Trial;
USA, 1973-1975
Cohort,
mortality
1990
(16)
348874/
826
14
Engeland,
1996 55
Cohort,
incidence
1993
(NR)
11863/
707
15
Cerhan, 1997
Migrant Study,
Norway; Norway,
1964-1965
Iowa 65+ Rural
Health Study; USA,
1981-1982
Cohort,
incidence
1993
(NR)
1050/ 71
56
16
Rodriguez,
1997 57
Cancer Prevention
Study II; USA, 1982
Cohort,
mortality
1991 (9)
450279/
1748
Smoking
category*
No.
cases*
RR (95% CI)*
15-24
25+
Never-smoker
Ever
Current
1-4 Cig/day
5-14
15+
Duration
1-20 years
21-30
31-40
41+
Non-smoker
Current
1-15 Cig/day
16-25
26-35
36-45
46+
Never-smoker
Ever
Current
Never-smoker
Ever
Current
1-19 Cig/day
20+
Cumulative use
1-30 pk-yr
31-55
56+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
239
38
198
511
343
80
141
76
1.14 (0.99-1.31)
1.00 (0.72-1.38)
Referent
1.16 (0.99-1.32)
1.26 (1.06-1.50)
0.99 (0.78-1.26)
1.13 (0.93-1.37)
1.05 (0.82-1.35)
42
75
134
85
514
312
79
102
58
57
16
139
568
451
26
45
15
6
9
1.41 (0.99-1.99)
1.28 (0.98-1.67)
1.19 (0.96-1.48)
1.28 (0.99-1.65)
Referent
1.31 (1.13-1.52)
1.54 (1.08-2.20)
1.27 (0.92-1.75)
1.23 (0.89-1.69)
1.50 (0.99-2.26)
1.22 (0.58-2.58)
Referent
1.0 (0.9-1.3)
1.1 (0.9-1.3)
Referent
1.4 (0.7-2.0)
2.2 (1.1-4.4)
1.8 (0.7-4.4)
2.7 (1.2-6.0)
14
12
16
485
897
339
42
74
1.3 (0.7-2.5)
1.3 (0.7-2.7)
2.0 (1.1-3.8)
Referent
1.09 (0.98-1.19)
1.34 (1.16-1.56)
1.33 (0.96-1.83)
1.58 (1.23-2.03)
Variables the results were adjusted for;
Other comments
Same as above
Age;
Adjusted RRs but no 95% CIs (we calculated 95%
CIs)
Age
Age
Age, race, education, alcohol intake, vegetable and
fat meat intakes, family history of prostate cancer,
vasectomy, exercise, BMI
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Study
design,
outcome
Last
FU
(FU a,
yrs.)
Total
no.
men/
cases b
17
Veierod,
1997 59
Norwegian health
screening; Norway,
1977-1983
Cohort,
incidence
1992
(12.4)
24051/
72
18
Giovannucci,
1999 60
Health Professionals
Follow-up Study;
USA, 1986
Cohort,
mortality
1994
(NR)
47781/
103
19
Heikkila,
1999 61
20
Parker, 1999
62
21
Will, 1999 63
22
Lotufo, 2000
64
Mobile Clinic Health
Examination Survey;
Finland, 1966-1972
Iowa farming; USA,
1986-1989
Nested
CCS,
incidence
Cohort,
incidence
1991
(NR)
16481/
166 (300)
1995
(NR)
1177/ 81
Cancer Prevention
Study I; USA, 19591960
Physicians' Health
Study; USA, 1982
Cohort,
incidence
1972
(NR)
305065/
2523
Cohort,
incidence
NR
(12.5)
21985/
996
Smoking
category*
No.
cases*
RR (95% CI)*
Variables the results were adjusted for;
Other comments
20-20
21+
Duration
1-25 years
26-35
36-45
46+
Never-smoker
Ever
Current
1-10 Cig/day
11+
Never-smoker
Ever
Current
Cumulative use c
1-9 pk-yr
10-14
15+
Non-smoker
Current
108
107
1.38 (1.10-1.71)
1.25 (1.00-1.57)
13
43
118
155
24
45
25
11
14
38
65
26
1.36 (0.77-2.38)
1.65 (1.17-2.34)
1.39 (1.11-1.75)
1.26 (1.04-1.53)
Referent
0.6 (0.3-0.8)
0.5 (0.2-0.8)
0.5 (0.3-1.1)
0.6 (0.3-1.2)
Referent
1.18 (0.76-1.57)
1.58 (0.81-3.10)
5
10
11
114
52
1.25 (0.50-3.10)
1.76 (0.91-3.42)
2.06 (1.08-3.90)
Referent
1.31 (0.87-1.95)d
Never-smoker
Ever
Current
1-19 Cig/day
20+
Non-smoker
Current
23
55
41
25
16
1267
1256
Referent
1.4 (0.8-2.0)
1.8 (0.6-2.9)
1.7 (0.8-3.8)
1.9 (0.8-4.5)
Referent
1.00 (0.92-1.08)
Age;
Retrospective cohort
Never-smoker
Ever
Current
1-19 Cig/day
20+
Cumulative use
<20 pk-yr
443
553
96
35
61
Referent
1.10 (0.97-1.28)
1.06 (0.83-1.29)
1.04 (0.73-1.48)
1.07 (0.82-1.41)
Age, alcohol intake, aspirin assignment, betacarotene assignment, physical activity, height, BMI
236
1.22 (1.04-1.43)
Age
Age, quintiles of intakes of calcium, total fat,
vitamin E and lycopene, BMI at age 21
None
Age
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Study
design,
outcome
Cohort,
mortality
23
24
Lund-Nilsen,
2000 65
Nomura,
2000 66
25
Visvanathan,
2004 67
26
Eichholzer,
2005 68
Nord-Trøndelag;
Norway, 1984-1986
Honolulu Heart
Program; USA,
1971-1977
Campaign against
Cancer and Stroke
(CLUE II); USA,
1989
Basel cohort study;
Switzerland, 19711973
Cohort,
incidence
Nested
CCS,
incidence
Last
FU
(FU a,
yrs.)
NR
(12.5)
1996
(9.3)
1995
(NR)
Total
no.
men/
cases b
20375/
113
22895/
644
9413/
249 (249)
Nested
CCS,
incidence
1996
(NR)
10178/
164 (324)
Cohort,
mortality
1990
(NR)
2974/ 30
Smoking
category*
No.
cases*
RR (95% CI)*
20-39
40+
Never-smoker
Ever
Current
1-19 Cig/day
20+
Cumulative use
0.25-19 pk-yr
20-39
40+
Never-smoker
Ever
Current
1-8 Cig/day
9-10
11-15
16+
Cumulative use
1-10 pk-yr
11-17
18-25
26+
Never-smoker
Ever
Current
(cumulative use)
1-30 pk-yr
31+
Never-smoker
Ever
Current
129
126
45
68
11
4
7
0.98 (0.81-1.19)
1.14 (0.93-1.40)
Referent
1.28 (0.82-1.74)
1.23 (0.63-2.41)
1.25 (0.45-3.49)
1.22 (0.54-2.74)
25
16
12
222
336
153
73
67
51
45
1.35 (0.82-2.23)
1.14 (0.64-2.05)
0.91 (0.47-1.75)
Referent
0.97 (0.83-1.12)
0.96 (0.78-1.19)
0.84 (0.64-1.10)
1.05 (0.79-1.39)
1.37 (1.00-1.88)
1.27 (0.91-1.76)
50
34
58
73
87
238
76
0.95 (0.70-1.30)
0.84 (0.58-1.21)
1.24 (0.92-1.67)
1.22 (0.93-1.60)
Referent
1.2 (0.9-1.6)
1.3 (0.8-2.0)
20
56
63
101
14
1.4 (0.7-2.9)
1.2 (0.8-2.0)
Referent
0.99 (0.63-1.36)
0.82 (0.39-1.71)
Non-smoker
Current
16
14
Referent
1.16 (0.56-2.38)d
Variables the results were adjusted for;
Other comments
Same as above
Age
Age
Age;
Of 10457 men included in the study, 279 men with
cancer (other than non-melanoma skin cancer) at
baseline were excluded
None
No.
27
First
author,
publication
year
Hultdin,
2005 69
28
Baglietto,
2006 70
29
Giovannucci,
2007 71
30
Gonzalez,
2007 11
31
Huxley, 2007
12
32
Ozasa, 2007
13
Study name (or
description);
country,
recruitment period
Northern Sweden
Health and Disease
Cohort; Sweden,
1985-1999
Melbourne
Collaborative Cohort
Study; Australia,
1990-1994
Health Professionals
Follow-up Study;
USA, 1986
Study
design,
outcome
Last
FU
(FU a,
yrs.)
NR
(4.9)
Total
no.
men/
cases b
37776/
254 (514)
Smoking
category*
No.
cases*
RR (95% CI)*
Variables the results were adjusted for;
Other comments
Never-smoker
Ever
Current
115
124
45
Referent
1.08 (0.79-1.48)d
0.93 (0.61-1.41)d
None
Cohort,
incidence
2003
(10.3)
16872/
732
Never-smoker
Ever
Current
291
430
76
Referent
0.94 (0.81-1.07)d
0.73 (0.56-0.94)d
None
Cohort,
incidence
2002
(NR)
47750/
3544
Never
Current/former
(quit ≤10yr)
NR
NR
Referent
0.98 (0.89-1.07)
Cohort,
mortality
2002
(NR)
47750/
312
NR
NR
Referent
1.41 (1.04-1.91)
Vitamins and
Lifestyle (VITAL);
USA, 2000-2002
Asia Pacific Cohort
Studies
Collaboration;
Australia, New
Zealand, 1966-1999
Asia, 1961-1998
Cohort,
incidence
2004
(3.3)
35244/
832
NR
(6.8)
54353/
265
303
516
62
NR
53
265
Referent
0.92 (0.70-1.20)
0.94 (0.82-1.05)
Referent
1.67 (1.12-2.45)
1.12 (1.03-1.22)
Age
Cohort,
mortality
Never-smoker
Current/former
(quit ≤10yr)
Never-smoker
Ever
Current
Never-smoker
Current
Increment of 5
Cig/day
Age, time period, race, family history of prostate
cancer, diabetes, intakes of total calories, processed
meat, fish, α-linolenic acid, tomato sauce and
vitamin E supplements, physical activity, height,
BMI at age 21
Same as above
Cohort,
mortality
NR
(6.8)
266499/
43
NR
26
43
Referent
0.57 (0.24-1.32)
0.77 (0.56-1.05)
Same as above
The Asian territories included China, Hong Kong,
Japan, Singapore, South Korea, Taiwan
Japan Collaborative
Cohort Study
(JACC), 1988-1990
Cohort,
mortality
2003
(12.5)
46178/
150
Never-smoker
Current
Increment of 5
Cig/day
Never-smoker
Ever
Current
<15 Cig/day
15-24
25+
Duration
<25 years
25-39
26
124
76
17
47
12
Referent
1.18 (0.79-1.57)
1.35 (0.88-2.09)
1.06 (0.58-1.94)
1.59 (0.99-2.55)
1.56 (0.78-3.13)
Age, area of study
1
12
0.83 (0.10-6.42)
1.10 (0.52-2.30)
Nested
CCS,
incidence
Age, diabetes, BMI;
The median FU was the median of FU for
individual studies, which varied from 2.5 to 24.7
years.
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Study
design,
outcome
Last
FU
(FU a,
yrs.)
Total
no.
men/
cases b
33
Park, 2007 14
Multiethnic Cohort
Study; USA, 19931996
Cohort,
incidence
2002 (8)
82483/
4404
34
Rohrmann,
2007 72
Private census
Washington County,
Maryland; USA,
1963
Cohort,
incidence
1978
(NR)
26810/
147
Cohort,
mortality
2000
(NR)
226810/
240
Cohort,
incidence
1994
(NR)
28292/
351
Cohort,
mortality
2000
(NR)
28292/
184
USA, 1975
Smoking
category*
No.
cases*
RR (95% CI)*
40+
Cumulative use
<20 pk-yr
20-39
40-59
60+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
20+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
20+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
20+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
20+
Never-smoker
Ever
Current
1-9 Cig/day
10-19
20+
58
1.45 (0.92-2.27)
4
33
27
7
1326
3073
673
264
277
132
34
88
45
5
23
17
56
161
104
21
49
34
94
213
85
10
49
26
44
120
59
5
31
23
0.71 (0.25-2.04)
1.58 (0.95-2.62)
1.41 (0.83-2.40)
1.32 (0.57-3.05)
Referent
0.99 (0.93-1.06)d
0.84 (0.76-0.92)d
1.07 (0.93-1.23)d
0.89 (0.78-1.02)d
0.54 (0.45-0.65)d
Referent
1.16 (0.84-1.60)
1.00 (0.63-1.59)
0.52 (0.20-1.33)
1.03 (0.60-1.79)
1.38 (0.75-2.54)
Referent
0.97 (0.76-1.23)
0.93 (0.67-1.29)
1.11 (0.67-1.84)
0.85 (0.57-1.25)
0.95 (0.62-1.47)
Referent
1.01 (0.83-1.24)
0.98 (0.73-1.33)
1.12 (0.58-2.15)
0.95 (0.67-1.35)
1.01 (0.65-1.57)
Referent
1.13 (0.85-1.49)
1.25 (0.84-1.87)
1.12 (0.44-2.82)
1.11 (0.70-1.77)
1.58 (0.94-2.64)
Variables the results were adjusted for;
Other comments
None
Age
Same as above
Same as above
Same as above
No.
35
First
author,
publication
year
Smit, 2007
15
36
Butler, 2009
17
37
38
Watters,
2009 18
Batty, 2011
19
39
Grundmark,
2011 20
40
Geybels,
Study name (or
description);
country,
recruitment period
Puerto Rico Heart
Health Program,
Puerto Rico, 19651968
Singapore Chinese
Health Study;
Singapore, 19931998
NIH-AARP; USA,
1995-1996
Study
design,
outcome
Total
no.
men/
cases b
9777/167
Smoking
category*
No.
cases*
RR (95% CI)*
Variables the results were adjusted for;
Other comments
Cohort,
mortality
Last
FU
(FU a,
yrs.)
2005
(NR)
Never-smoker
Ever
Current
51
116
43
Referent
1.16 (0.82-1.65)d
1.26 (0.82-1.94)d
None
Cohort,
incidence
2006
(10.4)
27293/
250
Never-smoker
Ever
1-12 Cig/day
13-22
23+
Duration
1-19 years
20-39
40+
Current
Never-smoker
Ever
Current
<21 Cig/day
21+
108
142
59
57
26
Referent
0.95 (0.74-1.16)
1.08 (0.79-1.49)
0.99 (0.71-1.37)
0.71 (0.46-1.10)
Age, interview year, dialect group, education,
intake of vitamin D and black tea;
Because of adjustment for dialect group, this
article was considered as adjusted for
race/ethnicity
23
52
67
73
5512
11128
1446
931
515
1.19 (0.76-1.87)
0.83 (0.59-1.15)
1.02 (0.74-1.41)
0.88 (0.65-1.19)
Referent
0.89 (0.86-0.91)
0.85 (0.80-0.90)
0.91 (0.84-0.97)
0.75 (0.69-0.83)
Never-smoker
Ever
Current
1-20 Cig/day
21+
Never-smoker
Ever
Current
105
289
64
39
25
123
428
203
Referent
1.13 (0.93-1.34)
1.69 (1.25-2.27)
1.79 (1.27-2.52)
1.54 (1.01-2.34)
Referent
1.03 (0.88-1.21)
1.14 (0.91-1.44)
Same as above
Cohort,
incidence
2003
(NR)
283312/
16640
Age, race, education, marital status, vigorous
physical activity, family history of prostate cancer,
diabetes, health disease, total energy, quintiles of
intake of α-tocopherol, calcium, red meat, fish,
tomato, α-linolenic acid, and selenium, height,
BMI, digital rectal examination, PSA
Cohort,
mortality
2005
(NR)
283312/
394
Whitehall I study;
UK, 1967-1970
Cohort,
mortality
2007
(NR)
17934/
551
Uppsala
Longitudinal Study
of Adult Men
(ULSAM); Sweden,
1970-1974
Netherlands Cohort
Study; Netherlands,
Cohort,
incidence
2003
(26.5)
2045/
208
Never-smoker
Ever
Current
69
139
86
Referent
0.67 (0.50-0.83)
0.60 (0.44-0.83)
None
Cohort,
incidence
2003
(17.3)
58279/
3451
Never
Ever
492
2957
Referent
1.01 (0.88-1.13)
Age, duration of smoking (smoking years),
frequency of smoking (Cig/day)
Age, marital status, SES, physical activity, height,
BMI, BP, FEV1, cholesterol, diabetes/ blood
glucose
No.
41
42
First
author,
publication
year
2012 21
Karlsen,
2012 22
Study name (or
description);
country,
recruitment period
1986
Study
design,
outcome
Danish Diet, Cancer
and Health Study;
Denmark, 1993-1997
Cohort,
incidence
20002002
(NR)
20914/
129
Karppi, 2012
Kuopio Ischaemic
Heart Disease Risk
Factor; Finland,
1984-1989
Cohort,
incidence
2008
(15)
997/ 68
23
Last
FU
(FU a,
yrs.)
Total
no.
men/
cases b
43
Shafique,
2012 24
Collaborative study;
Scotland, 1970-1972
Cohort,
incidence
2007
(28)
6017/
318
44
Tseng, 2012
Taiwan Insurance;
Taiwan, 1995-1998
Cohort,
mortality
2006
(NR)
39135/
105
Seoul Male Cancer
Cohort Study; South
Korea, 1991-1992
Cohort,
incidence
2008
(NR)
14450/87
25
45
Bae, 2013 26
Smoking
category*
No.
cases*
RR (95% CI)*
Current
1084
0.98 (0.82-1.18)
Non-smoker
Current
1-10 gr/day
11-20
21+
Non-smoker
Smoker
81
48
13
22
13
57
11
Referent
1.00 (0.70-1.43)d
1.28 (0.71-2.30)d
1.06 (0.66-1.69)d
0.81 (0.45-1.45)d
Referent
0.85 (0.76-0.95)d
Never
Ever
Current
Non-smoker
Smoker
68
250
136
41
64
Referent
1.08 (0.84-1.32)
0.93 (0.69-1.26)
Referent
1.09 (0.82-1.46)
Never-smoker
Ever
1-10 Cig/day
11-20
21-30
31+
Duration
1-10 years
11-20
21-30
31+
Cumulative use
1-10 pk-yr
29
57
1
10
20
22
Referent
0.65 (0.40-0.90)
1.16 (0.02-1.20)
0.82 (0.40-1.66)
0.56 (0.32-0.99)
0.63 (0.36-1.08)
6
16
30
5
0.65 (0.27-1.57)
0.55 (0.30-1.01)
0.89 (0.54-1.48)
0.53 (0.21-1.37)
8
0.53 (0.24-1.14)
Variables the results were adjusted for;
Other comments
None;
Repeated data on tobacco use were also collected
in follow-ups. Here only data collected in the
baseline are considered
None;
Smoking defined as smoking within last 30 days;
Another article from the this study reported RR
(95% CI) of 0.94 (0.82-1.09) per 10 pack-years,
adjusted for age, BMI, physical fitness, and intake
of alcohol, fat, fiber, and energy (Laukkanen JA,
Pukkala E, Rauramaa R, Makikallio TH, Toriola
AT, Kurl S. Cardiorespiratory fitness, lifestyle
factors and cancer risk and mortality in Finnish
men. Eur J Cancer 2010;46:355-63.)
Age, social class, alcohol intake, tea intake, BP,
BMI, cholesterol
Age, area of residence, BMI, diabetes type,
diabetes duration, insulin use;
Retrospective cohort using a national insurance
program’s records
Age
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Study
design,
outcome
Last
FU
(FU a,
yrs.)
Total
no.
men/
cases b
Smoking
category*
No.
cases*
RR (95% CI)*
11-15
16-20
21-34
35+
Current
Non-Smoker
Current
4
12
21
8
38
706
159
0.41 (0.14-1.14)
1.08 (0.56-2.09)
0.75 (0.43-1.29)
0.55 (0.25-1.19)
0.70 (0.43-1.13)
Referent
0.70 (0.59-0.84)d
46
Heikkila,
2013 27
IPD-Work
Consortium; Europe,
1985-2002
Cohort,
incidence
2008
(12)
116056/
865
47
Koutros,
2013 28
Nested
CCS,
incidence
2009
(3.4)
28243/
680 (824)
Never-smoker
Ever
Current
247
46
381
Referent
0.70 (0.58-0.84)d
0.50 (0.36-0.69)d
48
Lemogne,
2013 29
Prostate, Lung,
Colorectal and
Ovarian Cancer
Screening Trial
(PLCO); USA, 19932001
GAZEL study;
France, 1989
Cohort,
incidence
2009
(15.2)
8877/
412
NR
NR
NR
NR
NR
Referent
0.86 (0.73-1.00)
0.70 (0.52-0.88)
0.76 (0.55-1.05)
0.64 (0.44-0.95)
49
Onitilo, 2013
Marshfield Clinic;
USA, 1995-2009
Cohort,
incidence
2011
(NR)
33832/
3432
Never-smoker
Ever
Current
1-19 pk-yr
20+
Before DM onset
Never-smoker
Ever
After DM onset
Never-smoker
Ever
NR
NR
Referent
0.92 (0.85-1.18)
NR
NR
Referent
0.83 (0.74-0.94)
Never-smoker
Ever
Current
1-14 Cig/day
1547
3076
1080
420
Referent
0.93 (0.89-0.98)
0.90 (0.83-0.97)
0.97 (0.87-1.08)
30
50
Rohrmann,
2013 31
European
Prospective
Investigation into
Cancer and
Cohort,
incidence
2009
(11.9)
145112/
4623
Variables the results were adjusted for;
Other comments
None;
A pooled analysis of 12 independent studies in
Finland, France, the Netherlands, Sweden,
Denmark, UK. Partial overlap with Lemonge et al
2013 (GAZEL study), from which 252 prostate
cancer cases were included in this pooled analysis.
Last follow-ups in participating studies were
generally after 1995
None
Age, occupation, alcohol intake, fruit and vegetable
intake, BMI;
Partial overlap with Heikkila et al 2013 (IPD-Work
Consortium)
Date of birth, study time period, residence in the
study area, insurance status, BMI, and
comorbidities. We considered the results as
adjusted for age as they were adjusted for both
data of birth and study time period;
Retrospective cohort using medical records. In the
article, ever-use was the reference group. In order
to make these results consistent with results of
other studies, we changed the reference category
Age, study center, education, marital status, height,
weight, vigorous physical activity;
Conducted in Denmark, France, Germany, UK,
Greece, Italy, Spain, Norway, The Netherlands,
No.
First
author,
publication
year
Study name (or
description);
country,
recruitment period
Nutrition (EPIC);
Europe, 1992-2000
Study
design,
outcome
Cohort,
mortality
51
Sawada,
2013 32
Japan Public Health
Center-based
Prospective Study
(JPHC); Japan, 1990NR
Cohort,
incidence
Last
FU
(FU a,
yrs.)
2009
(11.9)
2010
(16)
Total
no.
men/
cases b
145112/
432
482018/
913
Smoking
category*
No.
cases*
RR (95% CI)*
Variables the results were adjusted for;
Other comments
15-24
25+
Duration
<10 years
10-19
20-29
30-39
40+
Never-smoker
Ever
Current
1-14 Cig/day
15-24
25+
Duration
<10 years
10-19
20-29
30-39
40+
Never-smoker
Ever
Current
(cumulative use)
1-19 pk-yr
20-39
40+
365
131
0.90 (0.80-1.01)
0.87 (0.73-1.05)
Sweden
10
24
94
401
526
128
304
121
40
40
21
0.78 (0.42-1.46)
0.91 (0.60-1.37)
0.87 (0.70-1.09)
0.90 (0.80-1.01)
0.92 (0.82-1.02)
Referent
1.06 (0.87-1.24)
1.27 (0.98-1.65)
1.19 (0.82-1.73)
1.31 (0.90-1.91)
1.81 (1.11-2.93)
0
1
7
33
80
257
647
380
–
–
1.26 (0.55-2.87)
1.28 (0.83-1.96)
1.38 (1.01-1.87)
Referent
0.80 (0.72-0.89)
0.79 (0.68-0.89)
53
194
133
0.67 (0.49-0.91)
0.84 (0.70-1.02)
0.80 (0.65-1.00)
Same as above
Age, public health center area, marital status,
diabetes, intake of alcohol, miso soup and Japanese
tea, BMI
Supplementary Table 1B. Characteristics of the six studies that included in systematic review but not in meta-analysis because they
did not provide enough information to do so.
No.
1
First
author,
publication
year
Weir, 1970
40
Study name (or
description);
country,
recruitment period
Labor union
members, California;
Study
design,
outcome
Cohort,
mortality
Last
FU
(FU a,
yrs.)
1962
(7)
Total
no.
men/
cases b
68153/
37
Smoking
category*
No.
cases*
RR (95% CI)*
Variables the results were adjusted for;
Other comments
Never-smoker
Ever
NR
NR
Referent
0.78 (NR, NS)
Age, duration of smoking
No.
2
3
First
author,
publication
year
Whittemore,
1984 41
Thune, 1994
51
4
Gann, 1995
52
Study name (or
description);
country,
recruitment period
USA, 1954-1957
Study
design,
outcome
Former College Men
and Women; USA,
1962-1966
Cohort,
incidence
1978
(NR)
33915/
16
Cohort,
mortality
Cohort,
incidence
1978
(NR)
1991
(NR)
Cohort,
mortality
Norway, three
counties; Norway,
1972-1978
Chicago Heart
Association cohort;
USA, 1967-1973
Icelandic
Cardiovascular Risk
Factor Study;
Iceland, 1967-1991
British Doctors
cohort; UK, 1951
Last
FU
(FU a,
yrs.)
Total
no.
men/
cases b
Smoking
category*
No.
cases*
RR (95% CI)*
≤0.5 pk-yr
~1
1.5+
NR
NR
NR
NR
16
0.58 (NR, NS)
0.98 (NR, NS)
0.78 (NR, NS)
NR (NR, NS)
NR
33915/
12
42067/
211
NR
NR
NR (NR, NS)
Same as above
Increment of 10
Cig/day
211
1.08 (0.90-1.30)
Age
1979
(19.2)
22367/
73
Increments of 5
Cig/day
73
1.02 (0.93-1.12)
Age, education, BMI, heart rate, BP, cholesterol,
postload plasma glucose
Cohort,
incidence
1995
(NR)
11366/
524
NR
524
NR (NR, NS)
NR
Cohort,
mortality
2001
34439
/878
Never-smoker
Current
1-14 Cig/day
15-24
25+
Specific
categories (see
comments)
NR
NR
NR
NR
NR
NR
Referent
1.01 (NR)
0.75 (NR)
1.11 (NR)
1.27 (NR)
0.78 (0.72-0.85)
Never or former
smoker
Current
127
Referent
94
0.59 (0.45-0.77)d
Age;
Mortality rates per 100,000 were 89.4 in neversmokers, 66.7 in 1-14 Cig/day, 99.6 in 15-24
Cig/day, and 113.3 among ≥25 Cig/ day current
smokers
Age, race, agent Orange exposure, BMI, finasteride
use, preoperative PSA level;
Smoking history was considered as a continuous
variable as follows: 0, lifetime nonsmoker; 1, quit
>14 years ago; 2, quit >7 years ago; 3, quit >4
years ago; 4, quit in the last year; and 5, current
smoker
None;
As the reference group included former smokers,
this study was not included in our meta-analysis
5
Tulinius,
1997 58
6
Doll, 2005 73
7
Chamie,
2008 16
Northern California
Veteran Affairs;
USA, 1962-1971
Cohort,
incidence
2006
(NR)
13144/
363
8
Li, 2011 74
Ohsaki Cohort
Study; Miyagi
Prefecture, Japan,
1995
Cohort,
incidence
2003
22458/
230
Variables the results were adjusted for;
Other comments
Adj., adjusted; BMI, body mass index; BP, blood pressure; CCS, case-control study; DM, diabetes mellitus; FEV1, forced expiratory
volume in one second; FU, follow-up; NR, not reported; NS, non-significant (95% CIs or p-values were not reported, but the authors
reported that were no significant association); pk-yr, pack-year; PSA, prostate-specific antigen; SES, socioeconomic status; yr, year
* Data on cigarette smoking. For qualitative measures of use, data on current cigarette smoking (at baseline) are shown in this table.
When these data were not available, quantitative data on ever smoking (if available) are presented. Quantitative measures of former
smoking are not shown.
a
The mean or median of follow-up in years.
b
The numbers in parentheses are the number of controls in nested case-control studies.
c
Cumulative use during previous decade
d
We calculated the risk estimates using frequency distributions only, comparing cases of prostate cancer (incident or death) with other
participants. Evidently, time at risk was not considered in these calculations.
Supplementary Table 2. The association between cigarette smoking (current smokers at
baseline) and prostate cancer incidence and mortality after various adjustments for potential
confounding factors
Variables the results
No. of
RR (95% CI)
I2 statistics P for
were adjusted for
articles
heterogeneity
Mortality
Overall
All articles
Age
Age, race/ethnicity
Age, SES
Age, BMI
Age, diabetes
Age, family history a
Age, SES, BMI b
1995 or earlier *
All articles
Age
Age, SES
Age, BMI
After 1995 *
All articles
Age
Age, SES
Age, BMI
Incidence
19
16
2
7
8
6
3
4
1.24 (1.18-1.31)
1.26 (1.18-1.34)
1.45 (1.17-1.80)
1.29 (1.18-1.40)
1.32 (1.16-1.50)
1.30 (1.12-1.51)
1.40 (1.24-1.59)
1.29 (1.10-1.52)
1
14
46
8
31
46
0
49
0.45
0.29
0.17
0.36
0.17
0.09
0.39
0.12
10
8
3
3
1.24 (1.17-1.31)
1.24 (1.17-1.31)
1.31 (1.18-1.45)
1.35 (1.17-1.55)
0
0
0
0
0.79
0.65
0.64
0.86
8
7
4
4
1.24 (1.11-1.39)
1.24 (1.10-1.41)
1.27 (1.06-1.51)
1.30 (1.07-1.58)
14
24
45
49
0.32
0.24
0.14
0.12
33
25
3
6
7
5
2
3
0.90 (0.85-0.96)
0.95 (0.89-1.01)
0.89 (0.77-1.04)
0.87 (0.82-0.93)
0.89 (0.81-0.98)
0.89 (0.80-0.98)
0.91 (0.79-1.04)
0.84 (0.76-0.92)
68
59
32
26
63
62
85
17
<0.001
<0.001
0.23
0.24
0.01
0.03
0.01
0.30
15
13
1
2
1.06 (0.98-1.15)
1.06 (0.97-1.15)
1.20 (0.81-1.77)
1.08 (0.88-1.33)
25
29
–
0
0.18
0.14
–
0.55
18
12
5
5
0.84 (0.79-0.89)
0.89 (0.84-0.93)
0.86 (0.83-0.91)
0.86 (0.78-0.95)
58
28
1
66
0.001
0.17
0.40
0.02
Overall
All articles
Age
Age, race/ethnicity
Age, SES
Age, BMI
Age, diabetes
Age, family history a
Age, SES, BMI b
1995 or earlier *
All articles
Age
Age, SES
Age, BMI
After 1995 *
All articles
Age
Age, SES
Age, BMI
BMI, body mass index; CI, confidence interval; SES, socioeconomic status; RR, relative risk
a
Family history of prostate cancer.
b
These factors were selected because of relatively higher number of articles with results adjusted
for them.
* Last follow-up in 1995 or earlier versus after 1995. In the results for prostate cancer mortality,
the last follow-up could not be abstracted from one of the articles,12 in which the results were
adjusted for age, diabetes, BMI, so the numbers of articles in the two time periods may not add
up to the total number of articles. Only selected factors are shown, because the analysis stratified
for other factors (race/ethnicity, diabetes, family history of prostate cancer, and combination of
age, BMI, and SES) yielded only one or no articles for both mortality and incidence of prostate
cancer.
Supplementary Table 3. The association between cigarette smoking (current smokers) at
baseline and prostate cancer incidence and mortality by geographical area
Variables the results
No. of
RR (95% CI)
I2 statistics P for
adjusted for
studies
heterogeneity
Mortality
Overall
United States
Europe
Australia, New Zealand a
Asia a
1995 or earlier *
United States
Europe
Australia, New Zealand
Asia
After 1995 *
United States
Europe
Australia, New Zealand
Asia
Incidence
9
6
1
4
1.28 (1.18-1.40)
1.23 (1.10-1.38)
1.67 (1.12-2.45)
1.10 (0.90-1.35)
27
0
–
5
0.19
0.96
–
0.37
6
3
0
1
1.24 (1.16-1.32)
1.26 (1.07-1.49)
–
1.10 (0.70-1.50)
0
0
–
–
0.46
0.79
–
–
3
3
0
2
1.30 (1.01-1.68)
1.20 (1.03-1.41)
–
1.16 (0.92-1.48)
59
0
–
0
0.06
0.81
–
0.42
Overall
United States
16
0.94 (0.86-1.03) 66
<0.001
Europe
13
0.89 (0.81-0.99) 74
<0.001
Australia, New Zealand 1
0.73 (0.56-0.95) –
–
Asia
3
0.80 (0.71-0.90) 0
0.70
1995 or earlier *
United States
10
1.05 (0.95-1.16) 15
0.30
Europe
5
1.07 (0.92-1.23) 40
0.16
Australia, New Zealand 0
–
–
–
Asia
0
–
–
–
After 1995 *
United States
6
0.85 (0.76-0.95) 74
0.002
Europe
8
0.84 (0.76-0.92) 59
0.02
Australia, New Zealand 1
0.73 (0.56-0.94) –
–
Asia
3
0.80 (0.71-0.90) 0
0.70
a
12
One of the studies reported the results on smoking and prostate cancer mortality in both
Australia/New Zealand and Asian regions. For this reason, this study has been counted twice
here.
* Last follow-up in 1995 or earlier versus after 1995. In the results for prostate cancer mortality,
the last follow-up could not be abstracted from the above article, which reported on both
Australia/New Zealand and Asian regions.12
Supplementary Table 4. Studies with indication of data collection on prostate cancer screening
First
author,
publication
year
Giovannucci,
1999 60
Outcome
Categories
No.
cases*
Mortality
RR (95% CI)*
Comment
The method of diagnosis of cancer was not
reported in this study, but the association between
smoking and prostate cancer mortality was slightly
stronger in those who had a normal DRE early in
the study, suggesting that prostate cancer might
progress more rapidly in smokers.
1986-1994 (total)
Metastatic
Fatal
152
103
Increment of 15 pack-years of
cigarettes smoked in the prior decade
1.55 (1.04-2.33)
1.77 (1.11-4.07)
1988-1994 (negative DRE in 1988)
Metastatic
Fatal
–
57
37
–
2.05 (1.12-3.75)
2.40 (1.17-4.91)
–
Hultdin,
2005 69
Incidence
Giovannucci,
2007 71
Incidence,
mortality
–
–
–
Gonzalez,
2007 11
Incidence
–
–
–
Watters,
2009 18
Incidence
PSA screened
Never
Current
No PSA test
Never
Current
Missing PSA test information
Never
Current
PSA screened
Never
Current
No PSA test
2684
554
Referent
0.95 (0.86-1.04)
492
213
Referent
0.92 (0.86-1.04)
2336
697
Referent
0.76 (0.70-0.83)
36
15
Referent
1.64 (0.95-2.83)
Mortality
PSA was done, but results were not reported by
smoking status. Cause of workup leading to
prostate cancer diagnosis was routine health
checkup (12%), local symptoms (55%), other
causes (13%), or not registered/missing (20%).
PSA testing in the prior 2 years was asked
biennially from 1994 to 2000. PSA screening
intensity was very high in the study population
and relatively equal across categories of smoking:
75% for never smokers and 70% for current
smokers.
PSA was done, but results were not reported by
smoking status. In 83% prostate cancer cases and
72% non-cases PSA test had been done within the
two years prior to baseline.
Current smokers were less likely to have been
screened with PSA (57%) and/or DRE (72%)
during the past 3 years than former and never
smokers (PSA 73% and DRE 85% in both).
First
author,
publication
year
Outcome
Categories
No.
cases*
RR (95% CI)*
15
18
Referent
2.30 (1.18-4.48)
Grundmark,
2011 20
Koutros,
2013 28
Incidence
Never
Current
Missing PSA test information
Never
Current
–
54
31
–
Referent
1.49 (0.97-2.30)
–
Incidence
–
–
–
Sawada,
2013 32
Incidence
All cases
Never smokers
0-20 pack-years
20-40 pack-years
≥40 pack-years
Cases detected by subjective
symptoms (not screening)
Never smokers
0-20 pack-years
20-40 pack-years
≥40 pack-years
257
53
194
133
Referent
0.67 (0.49-0.91)
0.84 (0.70-1.02)
0.80 (0.65-1.00)
59
13
46
43
Referent
0.82 (0.44-1.54)
0.95 (0.64-1.43)
1.12 (0.74-1.69)
Comment
Very few prostate cancer cases (<2%) were
diagnosed using PSA screening.
Men were randomized to either the control or
screening arm of the trial. To the screening arm, a
PSA test and digital rectal exam at baseline and
annually thereafter for 3 years, followed by 2 years
of screening with PSA alone was offered.
However, PSA results were not reported by
smoking status.
Smoking had a significant inverse association with
prostate cancer incidence in those who were
diagnosed with prostate cancer using screening,
but not in those who were diagnosed by subjective
symptoms.
39% of prostate cancers detected by PSA
screening and 45% of cancers detected by
subjective symptoms were current smokers.
DRE, digital rectal examination; PSA, prostate-specific antigen
Note: Here, only studies with any indication of collection of data on prostate cancer screening are presented. Some studies provided
prevalence of screening in the countries where the studies were conducted or used a cutoff year as a surrogate for screening status.
These studies were not included here as they did not provide information about actual screening prevalence in the study population
(either population or opportunistic screening).
Supplementary Figure 1. Funnel plot for publication bias for the studies reporting on current
smoking at baseline and mortality from prostate cancer
.8
.6
.4
.2
0
Funnel plot with pseudo 95% confidence limits
-1
-.5
0
.5
RR (log scale)
1
1.5
RR, relative risk.
Twenty one dots from 19 studies (two studies had two subgroups each).
The p-value for publication bias was 0.83 and 0.48 using the Begg and Mazumdar and the
Egger’s methods, respectively.
Supplementary Figure 2. The association between previous tobacco smoking (former smokers)
and prostate cancer mortality
First
Publication
Total
Tobacco
author
year
case#
Product
RR (95% CI)
Hsing
1990
137
Cigarette
1.90 (1.10, 3.30)
Hsing
1991
4607
Cigarette
1.13 (1.03, 1.24)
Tverdal
1993
32
Cigarette
1.76 (0.47, 7.98)
Adami
1996
709
Cigarette
1.03 (0.84, 1.33)
Rodriguez
1997
1748
Cigarette
0.99 (0.87, 1.12)
Giovannucci
1999
103
Cigarette
1.12 (0.67, 1.57)
Lotufo
2000
113
Cigarette
1.30 (0.87, 1.95)
Ozasa
2007
150
Cigarette
1.06 (0.66, 1.68)
Rohrmann
2007
240
Cigarette: 1963 cohort
1.01 (0.70, 1.46)
Rohrmann
2007
184
Cigarette: 1975 cohort
1.02 (0.69, 1.50)
Smit
2007
167
Cigarette
1.10 (0.76, 1.61)
Watters
2009
394
Cigarette
1.03 (0.83, 1.27)
Batty
2011
551
Cigarette
0.94 (0.76, 1.18)
Rohrmann
2013
432
Cigarette
0.96 (0.76, 1.21)
Cigarette
Subtotal (I-squared = 0.0%, p = 0.617)
1.06 (1.00, 1.13)
.
Other products
Hsing
1990
137
Smokeless
1.80 (0.80, 3.90)
Rodriguez
1997
1748
Pipe/cigar±Cigarette
0.91 (0.78, 1.08)
Subtotal (I-squared = 63.4%, p = 0.098)
1.14 (0.61, 2.14)
.
NOTE: Weights are from random effects analysis
.2
.5
1
2
5
Supplementary Figure 3. The association between ever tobacco smoking and prostate cancer
mortality
First
author
Publication
year
Total
case#
Use
Tobacco
Product
RR (95% CI)
Cigarette
Hammond
1958
185
Ever
Cigarette
Hammond
1966
343
Ever
Cigarette
Akiba
1990
147
Current Cigarette
Hsing
1990
137
Ever
Cigarette only
Hsing
1991
4607
Ever
Cigarette
Tverdal
1993
32
Ever
Cigarette
Adami
1996
709
Ever
Cigarette
Coughlin
1996
826
Current Cigarette
Rodriguez
1997
1748
Ever
Cigarette
Giovannucci 1999
103
Ever
Cigarette
Lotufo
2000
113
Ever
Cigarette
Eichholzer
2005
30
Current NR
Giovannucci 2007
312
Current Cigarette
Huxley
2007
43
Current Cigarette: Asia
Huxley
2007
265
Current Cigarette: Australia/New Zeland
Ozasa
2007
150
Ever
Cigarette
Rohrmann
2007
240
Ever
Cigarette: 1963 cohort
Rohrmann
2007
184
Ever
Cigarette: 1975 cohort
Smit
2007
167
Ever
Cigarette
Watters
2009
394
Ever
Cigarette
Batty
2011
551
Ever
Cigarette
Tseng
2012
105
Current Cigarette
Rohrmann
2013
432
Ever
Cigarette
Subtotal (I-squared = 36.1%, p = 0.044)
.
Other products
Hsing
1990
137
Ever
Smokeless only
Hsing
1990
137
Ever
Pipe/cigar only
Hsing
1991
4607
Ever
Pipe/cigar only
Hsing
1991
4607
Ever
Smokelss
Tverdal
1993
32
Current Pipe
Adami
1996
709
Ever
Snuff
Adami
1996
709
Ever
Pipe
Rodriguez
1997
1748
Ever
Pipe/cigar±Cigarette
Rohrmann
2007
240
Ever
Pipe/cigar: 1963 cohort
Rohrmann
2007
184
Ever
Pipe/cigar: 1975 cohort
Batty
2011
551
Current Pipe/cigar only
Subtotal (I-squared = 59.8%, p = 0.006)
.
NOTE: Weights are from random effects analysis
.5
1.75 (1.39, 2.17)
1.13 (0.74, 1.52)
1.10 (0.70, 1.50)
2.00 (1.10, 3.70)
1.16 (1.10, 1.22)
1.85 (0.71, 7.78)
1.16 (0.99, 1.32)
1.31 (1.13, 1.52)
1.09 (0.98, 1.19)
1.18 (0.76, 1.60)
1.28 (0.82, 1.74)
1.16 (0.56, 2.38)
1.41 (1.04, 1.91)
0.57 (0.24, 1.32)
1.67 (1.12, 2.45)
1.18 (0.79, 1.57)
0.97 (0.76, 1.23)
1.13 (0.85, 1.49)
1.16 (0.82, 1.65)
1.13 (0.93, 1.34)
1.03 (0.88, 1.21)
1.09 (0.82, 1.46)
1.06 (0.87, 1.24)
1.17 (1.11, 1.25)
4.50 (2.10, 9.70)
1.60 (0.70, 3.50)
1.10 (0.99, 1.22)
1.17 (0.88, 1.56)
0.89 (0.02, 8.97)
0.99 (0.82, 1.18)
1.07 (0.92, 1.23)
0.89 (0.78, 1.00)
0.94 (0.58, 1.54)
1.31 (0.77, 2.22)
1.14 (0.91, 1.44)
1.09 (0.97, 1.23)
1
2
5
10
Supplementary Figure 4. Association between current cigarette smoking at baseline and risk of
prostate cancer death by the year of last follow-up (1995 or earlier and after 1995)
First
Publication
author
year
Last
Country
Recruitment
Follow-up
RR (95% CI)
Last FU<=1995
Hsing
1991
United States
1954-1957
1980
1.18 (1.09, 1.28)
Akiba
1990
Japan
1965
1981
1.10 (0.70, 1.50)
Hsing
1990
United States
1966
1986
1.60 (1.00, 2.60)
Tverdal
1993
Norway
1972-1978
1988
1.92 (0.61, 7.96)
Coughlin
1996
United States
1973-1975
1990
1.31 (1.13, 1.52)
Eichholzer
2005
Switzerland
1971-1973
1990
1.16 (0.56, 2.38)
Adami
1996
Sweden
1971-1975
1991
1.26 (1.06, 1.50)
Rodriguez
1997
United States
1982
1991
1.34 (1.16, 1.56)
Giovannucci
1999
United States
1986
1994
1.58 (0.81, 3.10)
Lotufo
2000
United States
1982
1995
1.23 (0.63, 2.41)
Subtotal (I-squared = 0.0%, p = 0.786)
1.24 (1.17, 1.31)
.
Last FU>1995
Rohrmann
2007
United States
1963
2000
0.93 (0.67, 1.29)
Rohrmann
2007
United States
1975
2000
1.25 (0.84, 1.87)
Giovannucci
2007
United States
1986
2002
1.41 (1.04, 1.91)
Ozasa
2007
Japan
1988-1990
2003
1.35 (0.88, 2.09)
Smit
2007
Puerto Rico
1965-1968
2005
1.26 (0.82, 1.94)
Watters
2009
United States
1995-1996
2005
1.69 (1.25, 2.27)
Tseng
2012
Taiwan
1995-1998
2006
1.09 (0.82, 1.46)
Batty
2011
UK
1967-1970
2007
1.14 (0.91, 1.44)
Rohrmann
2013
Europe
1992-2000
2009
1.27 (0.98, 1.65)
Subtotal (I-squared = 13.6%, p = 0.321)
1.24 (1.11, 1.39)
.
NOTE: Weights are from random effects analysis
.2
Rohrmann et al (2007) 72 had two sub-populations.
.5
1
2
5
Supplementary Figure 5. The association between current tobacco smoking and risk of incident
prostate cancer
First
author
Publication
year
Total
case#
Tobacco
Product
RR (95% CI)
Cigarette
Mills
1989
172
Cigarette
Severson
1989
174
Cigarette
Thompson
1989
54
Cigarette
Hiatt
1994
238
Cigarette
Adami
1996
2368
Cigarette
Engeland
1996
707
Cigarette
Cerhan
1997
71
Cigarette
Veierod
1997
72
Cigarette
Heikkila
1999
166
Cigarette
Parker
1999
81
Cigarette
Will
1999
2523
Cigarette
Lotufo
2000
996
Cigarette
Lund-Nilsen
2000
644
Cigarette
Nomura
2000
249
Cigarette
Visvanathan
2004
164
Cigarette
Hultdin
2005
254
NR
Baglietto
2006
732
Cigarette
Giovannucci
2007
3544
Cigarette
Gonzalez
2007
832
Cigarette
Park
2007
4404
Cigarette
Rohrmann
2007
147
Cigarette: 1963 cohort
Rohrmann
2007
351
Cigarette: 1975 cohort
Butler
2009
250
Cigarette
Watters
2009
16640
Cigarette
Grundmark
2011
208
Cigarette
Geybels
2012
3451
Cigarette
Karppi
2012
68
Cigarette
Shafique
2012
318
Cigarette
Bae
2013
87
Cigarette
Heikkila
2013
865
NR
Koutros
2013
1122
Cigarette
Lemogne
2013
412
Cigarette
Rohrmann
2013
4623
Cigarette
Sawada
2013
913
Cigarette
Subtotal (I-squared = 67.6%, p = 0.000)
.
Other products
Koutros
2013
1122
Pipe/cigar
Subtotal (I-squared = .%, p = .)
.
NOTE: Weights are from random effects analysis
0.49 (0.16, 1.57)
0.87 (0.61, 1.23)
1.30 (0.70, 2.50)
1.20 (0.75, 1.64)
1.11 (1.01, 1.23)
1.10 (0.90, 1.30)
2.20 (1.10, 4.40)
0.54 (0.25, 0.84)
1.31 (0.87, 1.95)
1.78 (0.61, 2.94)
1.00 (0.92, 1.08)
1.06 (0.83, 1.29)
0.96 (0.78, 1.19)
1.30 (0.80, 2.00)
0.82 (0.39, 1.71)
0.93 (0.61, 1.41)
0.73 (0.56, 0.94)
0.98 (0.89, 1.07)
0.92 (0.70, 1.20)
0.84 (0.76, 0.92)
1.00 (0.63, 1.59)
0.98 (0.73, 1.33)
0.88 (0.65, 1.19)
0.85 (0.80, 0.90)
0.60 (0.44, 0.83)
0.98 (0.82, 1.18)
0.85 (0.76, 0.95)
0.93 (0.69, 1.26)
0.70 (0.43, 1.13)
0.70 (0.59, 0.84)
0.50 (0.36, 0.69)
0.70 (0.52, 0.88)
0.90 (0.83, 0.97)
0.79 (0.68, 0.89)
0.90 (0.85, 0.96)
0.79 (0.58, 1.09)
0.79 (0.58, 1.08)
.2
.5
1
2
5
Supplementary Figure 6. The association between amount of cigarette smoking at baseline and
prostate cancer incidence using meta-regression method
1.5
.5
1
Relative risk
2
2.5
All publications
0
10
20
30
Cigarettes per day
40
50
1.5
.5
1
Relative risk
2
2.5
Last follow-up in 1995 or earlier
0
10
20
Cigarettes per day
30
40
1.5
1
.5
Relative risk
2
2.5
Last follow-up after 1995
0
10
20
30
Cigarettes per day
40
50
Supplementary Figure 7. The association between cumulative cigarette smoking and prostate
cancer incidence using meta-regression method
.5
1
Relative risk
1.5
2
All publications
0
20
40
Cigarettes per day
60
80
1.5
.5
1
Relative risk
2
2.5
Last follow-up in 1995 or earlier
0
20
40
Cigarettes per day
60
80
1.5
1
.5
Relative risk
2
2.5
Last follow-up after 1995
0
20
40
Cigarettes per day
60
Supplementary Figure 8. The association between previous tobacco smoking (former smokers)
and risk of incident prostate cancer
First
author
Publication
year
Total
case#
Tobacco
Product
RR (95% CI)
Cigarette
Mills
1989
172
Cigarette
Severson
1989
174
Cigarette
Hiatt
1994
238
Cigarette
Adami
1996
2368
Cigarette
Engeland
1996
707
Cigarette
Cerhan
1997
71
Cigarette
Veierod
1997
72
Cigarette
Parker
1999
81
Cigarette
Lotufo
2000
996
Cigarette
Lund-Nilsen 2000
644
Cigarette
Nomura
2000
249
Cigarette
Visvanathan 2004
164
Cigarette
Hultdin
2005
254
NR
Baglietto
2006
732
Cigarette
Gonzalez
2007
832
Cigarette
Park
2007
4404
Cigarette
Rohrmann
2007
147
Cigarette: 1963 cohort
Rohrmann
2007
351
Cigarette: 1975 cohort
Butler
2009
250
Cigarette
Watters
2009
16640 Cigarette
Grundmark 2011
208
Cigarette
Geybels
2012
3451
Cigarette
Shafique
2012
318
Cigarette
Bae
2013
87
Cigarette
Koutros
2013
1122
Cigarette
Lemogne
2013
412
Cigarette
Rohrmann
2013
4623
Cigarette
Sawada
2013
913
Cigarette
Subtotal (I-squared = 61.2%, p = 0.000)
.
NOTE: Weights are from random effects analysis
.2
1.24 (0.91, 1.67)
0.89 (0.61, 1.29)
1.10 (0.80, 1.50)
1.09 (0.98, 1.22)
0.90 (0.70, 1.10)
1.20 (0.70, 2.10)
0.60 (0.30, 1.10)
1.30 (0.80, 2.20)
1.11 (0.98, 1.28)
0.98 (0.80, 1.19)
1.20 (0.80, 1.80)
1.07 (0.72, 1.60)
1.20 (0.84, 1.71)
1.12 (0.96, 1.32)
0.94 (0.81, 1.06)
1.05 (0.98, 1.12)
1.33 (0.85, 2.10)
1.04 (0.80, 1.36)
1.06 (0.78, 1.44)
0.90 (0.87, 0.93)
0.82 (0.58, 1.18)
1.03 (0.87, 1.23)
1.43 (1.05, 1.94)
0.60 (0.34, 1.06)
0.74 (0.62, 0.90)
1.07 (0.87, 1.28)
0.96 (0.90, 1.03)
0.84 (0.70, 1.00)
1.00 (0.95, 1.06)
.5
1
2
5
Supplementary Figure 9. The association between ever tobacco use and risk of incident
prostate cancer
First
author
Publication
year
Total
case#
Use
Cigarette
Mills
1989
172
Ever
Severson
1989
174
Ever
Thompson
1989
54
Current
Hiatt
1994
238
Ever
Le Marchand
1994
198
Ever
Adami
1996
2368
Ever
Engeland
1996
707
Ever
Cerhan
1997
71
Ever
Veierod
1997
72
Ever
Heikkila
1999
166
Current
Parker
1999
81
Ever
Will
1999
2523
Current
Lotufo
2000
996
Ever
Lund-Nilsen
2000
644
Ever
Nomura
2000
249
Ever
Visvanathan
2004
164
Ever
Hultdin
2005
254
Ever
Baglietto
2006
732
Ever
Giovannucci
2007
3544
Current
Gonzalez
2007
832
Ever
Park
2007
4404
Ever
Rohrmann
2007
147
Ever
Rohrmann
2007
351
Ever
Butler
2009
250
Ever
Watters
2009
16640
Ever
Grundmark
2011
208
Ever
Geybels
2012
3451
Ever
Karlsen
2012
129
Ever
Karppi
2012
68
Current
Shafique
2012
318
Ever
Bae
2013
87
Ever
Heikkila
2013
865
Current
Koutros
2013
1122
Ever
Lemogne
2013
412
Ever
Onitilo
2013
1310
Ever
Onitilo
2013
2122
Ever
Rohrmann
2013
4623
Ever
Sawada
2013
913
Ever
Subtotal (I-squared = 67.9%, p = 0.000)
.
Other products
Adami
1996
2368
Ever
Adami
1996
2368
Ever
Cerhan
1997
71
Ever
Cerhan
1997
71
Ever
Rohrmann
2007
147
Ever
Rohrmann
2007
351
Ever
Koutros
2013
1122
Current
Subtotal (I-squared = 0.0%, p = 0.439)
.
NOTE: Weights are from random effects analysis
Tobacco
Product
RR (95% CI)
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette
NR
Cigarette
Cigarette
Cigarette
Cigarette
Cigarette: 1963 cohort
Cigarette: 1975 cohort
Cigarette
Cigarette
Cigarette
Cigarette
All
Cigarette
Cigarette
Cigarette
NR
Cigarette
Cigarette
NR: After Diabetes onset
NR: Before diabetes onset
Cigarette
Cigarette
1.07 (0.74, 1.41)
0.88 (0.65, 1.11)
1.30 (0.70, 2.50)
1.14 (0.86, 1.41)
0.96 (0.70, 1.22)
1.10 (1.02, 1.18)
1.00 (0.90, 1.30)
1.35 (0.71, 2.00)
0.56 (0.33, 0.80)
1.31 (0.87, 1.95)
1.43 (0.83, 2.03)
1.00 (0.92, 1.08)
1.10 (0.97, 1.28)
0.97 (0.83, 1.11)
1.24 (0.86, 1.63)
0.99 (0.63, 1.36)
1.08 (0.79, 1.48)
0.94 (0.81, 1.07)
0.98 (0.89, 1.07)
0.94 (0.82, 1.05)
0.99 (0.93, 1.06)
1.16 (0.84, 1.60)
1.01 (0.83, 1.24)
0.95 (0.74, 1.16)
0.89 (0.86, 0.91)
0.67 (0.50, 0.83)
1.01 (0.88, 1.13)
1.00 (0.70, 1.43)
0.85 (0.76, 0.95)
1.08 (0.84, 1.32)
0.65 (0.40, 0.90)
0.70 (0.59, 0.84)
0.70 (0.58, 0.84)
0.86 (0.73, 1.00)
0.83 (0.74, 0.94)
0.92 (0.85, 1.18)
0.93 (0.89, 0.98)
0.80 (0.72, 0.89)
0.94 (0.90, 0.98)
Snuff
Pipe
Cigar
Pipe
Pipe/cigar: 1963 cohort
Pipe/cigar: 1975 cohort
Pipe/cigar
1.02 (0.93, 1.12)
1.03 (0.95, 1.10)
1.50 (0.90, 2.60)
1.00 (0.60, 1.60)
1.25 (0.75, 2.10)
1.19 (0.83, 1.70)
0.79 (0.58, 1.09)
1.03 (0.97, 1.09)
.5
1
2
5
10
Supplementary Figure 10. Association between current cigarette smoking at baseline and risk
of incident prostate cancer by the year of last follow-up (1995 or earlier and after 1995)
First
author
Publication
year
Country
Recruitment
Last FU<=1995
Will
1999
United States 1959-1960
Rohrmann
2007
United States 1963
Mills
1989
United States 1976
Hiatt
1994
United States 1978-1985
Severson
1989
United States 1965-1968
Thompson
1989
United States 1972-1974
Hultdin
2005
Sweden
1985-1999
Adami
1996
Sweden
1971-1975
Heikkila
1999
Finland
1966-1972
Veierod
1997
Norway
1977-1983
Cerhan
1997
United States 1981-1982
Engeland
1996
Norway
1964-1965
Rohrmann
2007
United States 1975
Lotufo
2000
United States 1982
Nomura
2000
United States 1971-1977
Parker
1999
United States 1986-1989
Subtotal (I-squared = 24.6%, p = 0.177)
.
Last FU>1995
Lund-Nilsen 2000
Norway
1984-1986
Visvanathan 2004
United States 1989
Giovannucci 2007
United States 1986
Park
2007
United States 1993-1996
Baglietto
2006
Australia
1990-1994
Geybels
2012
Netherlands
1986
Grundmark 2011
Sweden
1970-1974
Watters
2009
United States 1995-1996
Gonzalez
2007
United States 2000-2002
Butler
2009
Singapore
1993-1998
Shafique
2012
Scotland
1970-1972
Bae
2013
South Korea 1991-1992
Karppi
2012
Finland
1984-1989
Koutros
2013
United States 1993-2001
Lemogne
2013
France
1989
Rohrmann
2013
Europe
1992-2000
Sawada
2013
Japan
1990-NR
Heikkila
2013
Europe
Various 1985-2002
Subtotal (I-squared = 57.5%, p = 0.001)
.
NOTE: Weights are from random effects analysis
Last
Follow-up
RR (95% CI)
1972
1978
1982
1985
1986
1987
1990
1991
1991
1992
1993
1993
1994
1995
1995
1995
1.00 (0.92, 1.08)
1.00 (0.63, 1.59)
0.49 (0.16, 1.57)
1.20 (0.75, 1.64)
0.87 (0.61, 1.23)
1.30 (0.70, 2.50)
0.93 (0.61, 1.41)
1.11 (1.01, 1.23)
1.31 (0.87, 1.95)
0.54 (0.25, 0.84)
2.20 (1.10, 4.40)
1.10 (0.90, 1.30)
0.98 (0.73, 1.33)
1.06 (0.83, 1.29)
1.30 (0.80, 2.00)
1.78 (0.61, 2.94)
1.06 (0.98, 1.15)
1996
1996
2002
2002
2003
2003
2003
2003
2004
2006
2007
2008
2008
2009
2009
2009
2010
Generally >1995
0.96 (0.78, 1.19)
0.82 (0.39, 1.71)
0.98 (0.89, 1.07)
0.84 (0.76, 0.92)
0.73 (0.56, 0.94)
0.98 (0.82, 1.18)
0.60 (0.44, 0.83)
0.85 (0.80, 0.90)
0.92 (0.70, 1.20)
0.88 (0.65, 1.19)
0.93 (0.69, 1.26)
0.70 (0.43, 1.13)
0.85 (0.76, 0.95)
0.50 (0.36, 0.69)
0.70 (0.52, 0.88)
0.90 (0.83, 0.97)
0.79 (0.68, 0.89)
0.70 (0.59, 0.84)
0.84 (0.79, 0.89)
.2
Rohrmann et al (2007) 72 had two sub-populations.
.5
1
2
5
Supplementary File 1
Additional details for search method, abstraction of data, and statistical methods
[Please note that the reference list for this section is different from the list for the article,
Supplementary Tables 1 – 4, and Supplementary Figures 1 – 10 and is provided at the end of
this section.]
Search methods: We searched the PubMed and Web of Science databases to identify articles
from prospective cohort studies published in English on tobacco use and prostate cancer
incidence and mortality, following the Meta-Analysis of Observational Studies in Epidemiology
(MOOSE) guidelines.1 The terms used to search the PubMed database: (prostate cancer) AND
(tobacco OR smoking OR cigarette) AND (cohort OR prospective) AND English[Language].
The terms used to search the Web of Science database: TS=(prostate cancer) AND TS=(tobacco
OR smoking OR cigarette) AND TS=(cohort OR prospective). Only studies published in English
language were considered, as we expected few large cohort studies on smoking and prostate
cancer that were not published in English. All results were updated on January 21, 2014. Using
this approach, we identified a total of 1069 articles from the PubMed (499 articles) and Web of
Science (570 articles). From this list, 296 articles were excluded because they were retrieved
twice (from both databases), and we kept only one of them, leaving 773 articles in the list.
We examined article abstracts and retrieved and reviewed full texts of potentially eligible
articles. We included publications that met the following three criteria: reporting (i) original
research; (ii) human studies; (iii) prospective cohorts; and (iv) information about tobacco use and
prostate cancer. We included in our meta-analysis studies reporting relative risk estimates for the
association between tobacco use and prostate cancer incidence or mortality or information to
calculate these estimates (e.g. the number of cases and person-years of follow-up or number of
non-cases). We included in our systematic review, but we were not able to include in our metaanalysis articles that explicitly reported no significant associations between tobacco use and
prostate cancer, but did not present risk estimates or information to calculate them, or articles in
which some information was provided, but it was not enough to be included in the meta-analysis.
We also searched bibliographies of relevant articles to identify other publications not retrieved in
our electronic search; we found 26 additional publications potentially eligible, resulting in 799
potentially eligible articles. Abstracts (with no subsequent full text publications) and unpublished
studies were not considered.
We excluded 705 articles that did not meet the inclusion criteria. Among this group, there
were 162 articles on risk factors of prostate cancer incidence or mortality with no information on
smoking and prostate cancer: 22 articles were from studies in which smoking data had not been
collected (mainly census-based studies and retrospective occupational cohorts); 77 articles from
studies whose results were included in our meta-analysis using another article; and 63 articles
from 52 other studies with 459 prostate cancer deaths and 16,288 incident prostate cancer cases,
of which only 776 cases were from studies completed in 1995 or earlier (Supplementary File 1).
Of remaining articles with information on smoking and prostate cancer (n= 93), 26 articles were
excluded because similar or more complete data from the same cohort were available in another
included publication. Additional nine articles were excluded for other reasons (Figure 1). Of
remaining 59 articles,2-56 51 articles were included in the meta-analysis. We report results of the
other eight articles without including them in the meta-analysis,4,5,15,16,22,40,57 because they did not
provide enough information to do so. Two authors (FI, DM) independently performed the search,
evaluated the articles, and abstracted the data. Any inconsistency was solved by consensus.
Data abstraction: We abstracted data on first author; publication year; study name;
country; recruitment period; last follow-up and duration of follow-up; number of men at
baseline; number of prostate cancer cases or death; number of controls (for nested case-control
studies); relative risks (RR), including the risk ratios and hazard ratios, and 95% confidence
intervals (CI); and the variables for which the results were adjusted. The RRs (95% CIs) were
abstracted by tobacco product type separately. We indicated in the figures and tables the articles
reporting on smoking of all tobacco products combined only or without specifying the tobacco
product, but in the meta-analysis, those results were included in the analyses of cigarette
smoking, assuming all or the majority of tobacco users were cigarette smokers. We used the
maximally adjusted results when several risk estimates with various adjustments were reported.
Ever tobacco use was defined as follows. Some articles reported on ever tobacco use.
Some reported on both former and current tobacco use, so results on ever use could be calculated
by combining the results for former and current users. There were also studies that only reported
on current tobacco use (i.e. tobacco use at baseline). In this case, current users were considered
as ever users. Most studies reporting on amount of use presented their results on amount of use at
baseline. Two articles
17,42
reported both the average amount for ever use and the amount of use
at baseline. We included the latter measure in our analyses to be consistent with the measure
reported in other articles. Two articles reported on average amount for ever use but not amount
of use at baseline;14,41 in these cases, we considered the amount of ever use as amount of use at
baseline. When cigarette use was reported as grams of tobacco per day,46 we converted the
values to cigarette per day assuming each cigarette contained 0.8 grams of tobacco.58
Statistical analysis: We calculated the summary risk estimates and 95% CIs and plotted
Forest-plots using random effects models (DerSimonian-Laird method)
59
for the association
between current, former, and ever tobacco use and prostate cancer incidence and mortality
separately. We reported results for cigarette smoking, and when available, for other tobacco
products. When RR (95% CI) for current or ever tobacco consumption was not reported but RRs
(95% CIs) for several categories of quantitative use among current users or among current and
former users were available, we applied a fixed effects meta-analytic approach to calculate
combined risk estimated for current or ever tobacco consumption, respectively. Three articles
reported adjusted RRs without 95% CIs.2,3,18 In these cases, we calculated unadjusted 95% CIs
using frequency distributions and multiplied the standard error of the unadjusted RR by 1.5; we
considered this value as the standard error of the adjusted RR and estimated the adjusted 95%
CI.60 One study reported 90% CIs,8 which we converted to 95% CIs. Heterogeneity among
articles was estimated using the I2 statistic and p-values associated with Q statistics. I2 statistic
indicates the percentage of total variability explained by heterogeneity, and values of 25%, 50%,
and 75% are arbitrarily considered as indicative of low, moderate, and high heterogeneity,
respectively.61 We plotted funnel plots and used Egger’s weighted regression method and the
Begg and Mazumdar adjusted rank correlation test to examine publication bias.
We also applied random effects meta-regression models, when information on
quantitative use of tobacco and prostate cancer was reported, and presented a linear prediction of
the fitted values. We did not apply meta-regression analysis to former cigarette smoking, because
few articles reported quantitative measures for former smokers. Furthermore, the association
between former tobacco use and prostate cancer risk, if any, could be influenced by the duration
of time since quitting smoking. Also, as little quantitative data were available on tobacco
products other than cigarette, we only include cigarette smoking in our meta-regression analysis.
The midpoint of each exposure category was considered as the dose associated to the RR (95%
CI) for that category. For the open-ended upper category of use, we multiplied its lower bound
by 1.5 to estimate the exposure level.62
Subgroup analyses were conducted for results controlling (either by standardization or
statistical adjustments) for age, race/ethnicity; socioeconomic status (any of income, education
level, occupation, or insurance status), BMI, and history of diabetes mellitus, as main potential
confounding factors. We performed analyses stratified by geographical area and by time of study
completion (last follow-up before/during versus after 1995). The latter was done to investigate
the associations in the era before PSA screening for prostate cancer became widespread, which
first started around the mid-1990s, mainly in the United States.63-65 The widespread use of PSA
screening after the mid-1990s may not be homogenous across countries, as the starting time and
extent of use were not the same in various regions. Nevertheless, while no cut-off is perfect, a
cutoff of 1995 is reasonable to identify pre PSA screening era studies, which were the main
focus of this subgroup analysis. For two articles that reported the recruitment and mean/median
follow-up periods but not the last follow-up year, we added the mean/median follow-up time to
mid-recruitment period.28,33 We did not do this for another article from a pooled analysis that
also reported recruitment and mean/median follow-up periods because of high variation of these
values in individual studies (recruitment from 1961 to 1999, follow-up from 2.5 to 24.7 years);37
this article was the only article that was not included in this sub-group analysis because of lack
of information on last follow-up.
We also calculated population attributable risk (PAR) for smoking and prostate cancer
death in the United States and Europe, as most studies were from these two regions, using the
following formula:66
𝑝𝑟 × (𝑅𝑅−1)
𝑃𝐴𝑅 = [𝑝𝑟 × (𝑅𝑅−1)]+1
in which pr was the smoking prevalence in the population.67,68 Using these PARs and the number
of prostate cancer deaths in those region,64,69 the number of prostate cancer deaths attributable to
smoking were calculated. All statistical analyses were performed using Stata (StataCorp LP, TX;
version 11) statistical software. Throughout the article, associations with 95% CIs that do not
include unity or two-sided p-values <0.05 were considered as statistically significant.
Articles from studies in which data on smoking at individual levels were not available in
their datasets
First author,
publication
year
Tyroler, 1976 70
Saftlas, 1987 71
Beral, 1988 72
Andjelkovich,
1990 73
Adami, 1992 74
Evanoff, 1993 75
Guberan, 1993 76
Faggiano, 1994
77
Kross, 1996 78
Szadkowska-
Study name or area
Study period
Outcome
No of
cases
No of
articles
Cohort of rubber workers,
Akron, USA
Cohort of Wisconsin farmers,
USA
Cohort of employees of the
Atomic Weapons
Establishment, UK
Cohort of foundry workers,
Michigan, USA
Cohort of persons with a
discharge diagnosis of
alcoholism, Uppsala, Sweden
Swedish chimney sweeps
1964-1972
Mortality
582
1
1968-1976
Mortality
1016
1
1981-1982
Mortality
99
1
1950-1984
Mortality
5
1
1965-1984
Incidence
68
1
1951-1990
1942-1990
1981-1987
45 cases,
22 deaths
24 cases,
23 deaths
174
1
Cohort of self-employed
butchers, Geneva, Switzerland
Cancer registry data, Turin,
Italy
Cohort of golf course
superintendents, USA
Cohort of workers of the pulp
Incidence,
Mortality
Incidence,
Mortality
Incidence
1970-1992
Mortality
18
1
1968-1995
Mortality
5
1
1
1
Stańczyk, 1998 79
Dreyer, 1999 80
Fleming, 1999 81
Fleming, 1999 82
Verkasalo, 1999
and paper industry, Poland
Cohort of atherosclerotic
patients, Danish National
Registry of Patients
Cohort of licensed pesticide
applicators, Florida, United
States
Finnish Twin Cohort Study
1977-1993
Incidence
449
1
1975-1993
Incidence,
Mortality
353 cases,
64 deaths
2
1976-1995
Incidence
41
1
83
A retrospective cohort study
of trihalomethane exposure
through drinking water,
Guastalla, Italy
85
Danish Psychiatric Central
Dalton, 2005
Mortensen, 1994 Register (also Danish
86
Psychiatric Case Register)
87
Adult and Adolescent
Patel, 2008
Spectrum of HIV Disease
Project, and HIV Outpatient
Study
88
Cohort of Australian
Gun, 2008
participants in the British
nuclear tests in Australia
Nationwide population-based
Dalton, 2008 89
study in Denmark
Pukkala, 2009 90 Follow-up of 15 million
people in five Nordic
countries for occupation and
cancer using census data
Kristbjornsdottir, Population utilizing
geothermal hot water, Iceland
2013 91
1
Vinceti, 2004 84
1969-1993
Incidence
28
2
1992-2003
Incidence
39
1
1982-2001
Incidence,
Mortality
548 cases,
136 deaths
1
1994-2006
Incidence
NR
1
1960-2005
Incidence
339,973
1
1981-2010
Incidence
1093
1
Total
22
Articles that were excluded because another article from the same study were included in
our systematic review or were excluded for specific reasons*
First author, publication
year
Hirayama, 1985 92
Whittemore, 1985 93
Knekt, 1988 94
Chyou, 1994 95
Kolonel, 1994 96
Kato, 1992 97
Heilbrun, 1991 98
Nomura, 1986 99
Pollack, 1984 100
Heilbrun, 1982 101
Study name or area
Six-Prefecture Cohort Study; Japan
Former College Men and Women
Mobile Clinic Health Examination Survey; Finland
Men of Japanese ancestry in Hawaii (also known as JapanHawaii Cancer Study and Honolulu Heart Program)
No of
articles
1
1
1
7
Cerhan, 1999 102
Eichholzer, 2000 103
Doll, 1994 104
Van Guelpen, 2006 105
Stattin, 2004 106
Kubo, 2006 107
Batty, 2006 108
Nishi, 2008 109
Mursu, 2008 110
Crespo, 2008 111
Hellevik, 2009 112
Driver, 2010 113
Ma, 2008 114
Driver, 2007 115
Chan, 2002 116
Chan, 2001 117
Liu, 2000 118
Hubert, 1997 119
Watters, 2010 120
Mouw, 2008 121
Stocks, 2010 122
Knutsson, 2000 123
Park, 2011 124
Mondul, 2011 125
Hirvonen, 2010 126
Ahn, 2008 127
Sequoia, 2007 128
Weinstein, 2007 129
Malila, 2006 130
Weinstein, 2006 131
Männistö, 2003 132
Paltoo, 2003 133
Virtamo, 2003 134
Hirvonen, 2001 135
Chan, 2000 136
Dorgan, 1998 137
Hartman, 1998 138
Hartman, 1998 139
Silverberg, 2011 140
Ferrara, 2011 141
Yeh, 2012 142
Jakszyn, 2012 143
Iowa 65+ Rural Health Study
Basel cohort study
British Doctors cohort
Northern Sweden Health and Disease Cohort
1
1
1
2
Japan Collaborative Cohort Study
Whitehall study
Lifespan Study (atomic bomb survivors), Japan
Other articles with data on smoking and prostate cancer
from this study were excluded from this analysis because
they were on atomic bomb survivors.
Kuopio Ischaemic Heart Disease Risk Factor
Puerto Rico Heart Health Program
Nord-Trøndelag
Physicians' Health Study
1
1
1
NIH-AARP
2
Swedish Construction workers
2
Multiethnic Cohort Study
Alpha-Tocopherol Beta-carotene Cancer prevention study
(ATBC)
Articles with data on smoking and prostate cancer from
this study were excluded from this analysis because there
were few non-smokers at baseline.
1
15
Kaiser Permanente Medical Care Program, USA
2
CLUE II
European Prospective Investigation into Cancer and
Nutrition (EPIC)
1
7
1
1
1
7
Nimptsch, 2010 144
Heidemann, 2009 145
Allen, 2008 146
Crowe, 2008 147
Pischon, 2008 148
Rohrmann, 2008 149
Xiao, 2013 150
Kirsh, 2007 151
Peters, 2007 152
Kirsh, 2006 153
Mondul, 2013 154
Wilson, 2011 155
Kasper, 2009 156
Michaud, 2008 157
Platz, 2004 158
Chan, 1999 159
Giovannucci, 1998 160
Giovannucci, 1993 161
Campbell, 2012 162
Rodriguez, 2004 163
Rodriguez, 2002 164
Chung, 2013 165
Liang, 2012 166
Liang, 2012 167
van den Brandt, 2003 168
Prostate, Lung, Colorectal and Ovarian Cancer Screening
Trial (PLCO)
4
Health Professionals Follow-up Study
8
Cancer Prevention Study (I or II)
3
Taiwan Insurance (Longitudinal Health Insurance study)
3
Netherlands Cohort Study
1
Total 77
* The excluded studies included: pooled analyses when data from all original articles were
included in our analysis; studies of atomic bomb survivors (Lifespan study); and studies with few
non-smokers at baseline (ATBC study).
Studies on prostate cancer identified in our literature search but not included in our
systematic review because of lack of information on the association between smoking and
prostate cancer
First author,
publication year
Study name or area
Study
period
Outcome
Greenwald, 1974
Cohort of patients with
benign prostatic
hyperplasia and a
control group, Boston,
USA
Stockholm Prospective
Study, Sweden
1940-1970
Incidence
1961-NR
(recruitment
Mortality
169
Böttiger, 1982 170
No of cases
(maximum
when several
studies)
50
No of
articles
1
Last
follow-up
in 1995 or
earlier
+
NR, but a total
of 23 genital
1
+
Khaw, 1984 171
Cohort of elderly
individuals, southern
California, USA
Thun, 1985 172
Cohort of cadmium
production workers,
USA
Leisure World, Laguna
Hills, California, USA
Cohort of 20,000
people in London, UK
Cohort of shipyard and
machine shop male
workers
Paganini, 1987 173
Kinlen, 1988 174
Tola, 1988 175
Reichman, 1990
176
Albanes, 1989 177
Wingren, 1990 178
Giovannucci,
1993 179
Oliveria, 1996 180
Trivers, 1996 181
Blair, 1998 182
Chen, 1988 183
Key, 1999 184
Key, 1998 185
1961-1962;
average FU,
14.5 years)
1972-NR
(recruitment
1972-1974;
average FU,
9 years)
1940-1978
carcinomas in
male
Mortality
8
1
+
Mortality
3
1
+
1981-1986
Incidence
92
1
+
1967-1986
Mortality
88
1
+
1945-1981
Incidence
1
+
National Health and
Nutrition Examination
Survey (NHANES)
Cohort of Swedish
glassworkers
1971-1984
Incidence
48 [However,
smoking history
was available
for 8% of study
participants]
84
2
+
1964-1985
Mortality
1
+
Cohort of husbands of
participants in the
Nurses' Health Study
Cohort of persons
receiving a voluntary,
preventive medical
examination, Dallas,
USA
Lung Health Study,
USA
Cohort of workers
exposed to
dimethylformamide
and/or acrylonitrile,
USA
1976-1989
Incidence
4 [However,
smoking history
was available
for 10% of
study
participants]
96
1
+
1971-1989
Incidence
94
1
+
NR
Incidence
5
1
+*
1956-1989
Mortality
2
+
Pooled analysis of 5
cohorts (Adventist
Mortality, Health Food
Shoppers, Adventist
Health, Heidelberg,
Oxford Vegetarian)
1960-1995
Mortality
26 [However,
smoking history
was available
for 10% of
study
participants]
71 (137 deaths
in total, but 66
deaths from
Adventist
Health Study
are included in
2
+
Ritz, 1999
186
Stang, 1999 187
Zhang, 1999 188
Davey Smith,
2000 189
Kalish, 2000
190
Pukkala, 2000 191
Patja, 2001 192
Tsai, 2001 193
Wannamethee,
2001 194
Duffield-Lillico,
2002 195
Gunnel, 2003 196
Heijmans, 2003
197
Berndt, 2005 198
Brooks, 2001 199
Galobardes, 2005
200
Okasha, 2002 201
Gun, 2006 202
Gun, 2004 203
Nilsen, 2006 204
Jenkins, 2007 205
Silverberg, 2007
Cohort of workers
exposed to chemicals
during uranium
processing, USA
1951-1989
Mortality
East Boston Senior
Health Project, USA
Framingham heart
study, Massachusetts,
USA
Renfrew/Paisley
general population
study, Scotland, UK
1986-1990
Incidence
our analysis)
24 [However,
smoking history
was available
for 20% of
study
participants]
21
1948-1993
Incidence
1972-NR
(recruitment
1972-1976;
average FU,
20 years)
1987-1997
1
+
1
+
141
1
+
Mortality
59
1
+
Incidence
57
1
–
1967-1995
Incidence
69
1
+
1962-1997
Incidence
3
1
–
1973-1998
Mortality
16
1
–
1978-1997
Incidence
120
1
–
1983-1996
Incidence
64
1
–
1979-2000
Incidence
33
1
–
Zutphen Elderly Study,
the Netherlands
Baltimore Longitudinal
Study of Aging, USA
Glasgow Alumni
Cohort, Scotland, UK
1985-1995
Incidence
21
1
+
1984-2001
Incidence
62
1
–
1948-2004
Mortality
43
2
–
Australian petroleum
industry cohort
HUNT Study, NordTrøndelag County,
Norway
Cohort of peptic ulcer
surgery patients,
Glasgow, UK
Strategies for
1981-1999
251 cases, 35
deaths
957
2
–
1984-2002
Incidence,
Mortality
Incidence
1
–
1965-1995
Incidence
9
1
+
2002-2006
Incidence
6
1
–
Massachusetts Male
Aging Study, USA
Cohort of Finnish
world class male
athletes
Cohort of people with
intellectual disability,
Finland
Cohort of refinery
employees, California,
USA
British Regional Heart
Study, UK
Nutritional Prevention
of Cancer Trial, USA
Caerphilly Study, UK
206
McGlynn, 2008
207
Pedrazzoli, 2008
208
Rapp, 2008 209
Pham, 2009 210
Whitley, 2009 211
van der Pols, 2007
Management of
Antiretroviral Therapy
(SMART) trial,
international
Cohort of persons with
osteoporosis, Denmark
Cohort of patients with
chronic pancreatitis,
Padova, Italy
Vorarlberg Health
Monitoring and
Prevention Program,
Austria
Miyako Study,
Fukuoka Prefecture,
Japan
Boyd Orr cohort, UK
212
Koutros, 2010 213
Koutros, 2008 214
Alavanja, 2005 215
Gundling, 2011
216
Kubo, 2011 217
Chan, 2012 218
Dankner, 2012 219
Jonasson, 2012 220
Jonasson,, 2009
Agricultural Health
Study, Iowa and North
Carolina, USA
Cohort of patients with
cirrhosis, Munich,
Germany
Cohort of rotatingshift workers, Japan
Osteoporotic Fractures
in Men (MrOS) Study,
USA
Israel Study of Glucose
Intolerance, Obesity
and Hypertension
Swedish National
Diabetes Register
1978-1993
Incidence
46
1
+
1970-1999
Mortality
1
1
–
1985-2003
Incidence
796
1
–
1986-2003
Mortality
21
1
–
1937-NR
(recruitment
1937-1939;
followed-up
over 59
years)
1993-2006
Incidence
33
2
–
Incidence
1792
3
–
2005-2008
Incidence
6
1
–
1981-2009
Incidence
17
1
–
2000-2008
Incidence
356
1
–
1977-NR
(mean
follow-up
21.7 years)
1997-2009
Incidence
332
1
–
Incidence
740
2
–
1994-2011
Incidence
5
1
–
NR (a 4 year
study after
1995]
Incidence
1517
1
–
221
Karczewski, 2012
222
Freedland, 2013
223
Cohort of patients with
kidney transplantation,
Poznan, Poland
REDUCE clinical trial
(those with serum PSA
of 2.5-10 ng/ml if aged
50-60 years or 3-10
ng/ml if ≥60 years,
and a negative biopsy
within 6 months before
Hippisley-Cox,
2013 224
Bhaskaran, 2012
enrollment)
General Practice
Research Database,
UK
1986-2012
Incidence
7531
3
–
Cohort of patients with
inflammatory bowel
disease in North
Jutland County,
Denmark
Tromsø Study, Norway
1978-2002
Incidence
NR, but 29
male organ
cancers in total
1
–
1974-2008
Incidence
338
2
–
PRIME (Prospective
Epidemiological Study
of Myocardial
Infarction) cohort,
France
Framingham heart
study-offspring cohort
Cohort of
underground and
surface goldminers in
Western Australia
1991-NR (10
year followup)
Incidence
126
1
–
1971-2008
Incidence
219
1
–
1961-2009
Incidence,
Mortality
122 cases, 37
deaths
1
–
Total
63
225
Walker, 2011 226
Jess, 2013 227
Jorde, 2013 228
Jørgensen, 2008
229
Marrer, 2013 230
Parekh, 2013 231
Peters, 2013 232
* Based on publication year.
These 63 articles were from 52 studies with 459 prostate cancer deaths and 16,288 incident
prostate cancer cases, of which only 776 cases were from studies completed in 1995 or earlier.
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