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. 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