While previous studies have linked smoking to adverse outcomes in prostate cancer, including death, this study argues that the higher rate of prostate cancer–related death among smokers is a real effect with a biological cause, Stephen J. Freedland, MD, said in an editorial.

The current study included only men healthy enough to undergo aggressive treatment, which is an “important and necessary step to level the playing field,” Dr. Freedland wrote.

In that context, current smokers in this study had an 89% increased risk of prostate cancer–related death. “This finding shows that when we treat patients equally and minimize deaths from other causes, there is a stronger link between smoking and death from prostate cancer,” Dr. Freedland noted.

The finding also supports the notion that many smokers won’t live long enough to die from prostate cancer, given its slow-growing nature and the effects of smoking on competing causes of death, he added.

A scenario in which smokers did not live long enough to die of prostate cancer would predict a lower risk of prostate cancer–related death among smokers, he explained.

Because smoking has such clear adverse effects, physicians of all specialties should be hypervigilant about urging patients to quit smoking, Dr. Freedland concluded.

“If all of us remembered we are physicians first and oncologists and/or prostate cancer experts second, we will realize we are uniquely poised to help our patients, as the time of a new cancer diagnosis is a teachable moment when patients are very receptive to overall health advice,” he wrote.

Dr. Freedland is with the Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles. These comments are derived from his editorial in JAMA Oncology. Dr. Freeland had no reported conflict of interest disclosures.