Department of Urology, Ludwig-Maximilians University (LMU) Munich, Munich, Germany.
Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.
Eur Urol Focus. 2019 Sep;5(5):756-787. doi: 10.1016/j.euf.2018.02.007. Epub 2018 Mar 23.
Smoking, sexual activity, and physical activity (PA) are discussed as modifiable lifestyle factors associated with prostate cancer (PCa) development and progression.
To evaluate the available evidence concerning the association of smoking, sexual activity, and sports and exercise on PCa risk, treatment outcome, progression, and cancer-specific mortality.
A systematic review of studies published between 2007 and 2017 using MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement criteria was conducted.
While data concerning the impact of smoking on PCa development remain conflicting, there is robust evidence that smoking is associated with aggressive tumor features and worse cancer-related outcome, which seems to be maintained for 10 yr after smoking cessation. Less convincing and limited evidence exists for the association of sexual activity with PCa risk. The findings related to PA and PCa support the inference that exercise might be a useful factor in the prevention of PCa and tumor progression, while it is not finally proved under which specific conditions PA might be protective against disease development.
Smoking is associated with aggressive tumor features and worse cancer-related prognosis; as this negative impact seems to be maintained for 10yr after smoking cessation, urologists should advise men to quit smoking latest at PCa diagnosis to improve their prognosis. As several studies indicate a positive impact of exercise on tumor development, progression, and treatment outcome, it is certainly reasonable to advocate an active lifestyle. Least convincing evidence is available for the interaction of sexual activity and PCa, and well-conducted and longitudinal studies are clearly necessary to evaluate whether the suggested associations between PCa risk and sexual behavior are real or spurious.
In this systematic review, we looked at the impact of smoking, sexual activity, and sports and exercise on prostate cancer risk and outcome after treatment. While the evidence for sexual activity is not overall clear, we found that smoking might lead to more aggressive cancers and result in worse treatment outcome. Physical activity might prevent prostate cancer and improve cancer-related outcomes as well. Hence, it is certainly reasonable to advocate an active lifestyle and advise men to quit smoking.
吸烟、性行为和身体活动（PA）被讨论为与前列腺癌（PCa）发展和进展相关的可改变生活方式因素。
评估有关吸烟、性行为和运动与锻炼对 PCa 风险、治疗结果、进展和癌症特异性死亡率的关联的现有证据。
根据系统评价和荟萃分析的首选报告项目声明标准，使用 MEDLINE（通过 PubMed）、Cochrane 对照试验中心注册库和 Web of Science 数据库对 2007 年至 2017 年期间发表的研究进行了系统评价。
虽然有关吸烟对 PCa 发展影响的数据仍然存在争议，但有强有力的证据表明吸烟与侵袭性肿瘤特征和更差的癌症相关结局相关，这种关联似乎在戒烟后 10 年内仍然存在。性行为与 PCa 风险的关联存在较少且有限的证据。与 PA 和 PCa 相关的发现支持这样的推断，即锻炼可能是预防 PCa 和肿瘤进展的有用因素，而在何种特定条件下 PA 可能对疾病发展具有保护作用，这仍未最终确定。
吸烟与侵袭性肿瘤特征和更差的癌症相关预后相关；由于这种负面影响似乎在戒烟后 10 年内仍然存在，因此泌尿科医生应建议男性在 PCa 诊断时最晚戒烟，以改善其预后。由于多项研究表明锻炼对肿瘤发展、进展和治疗结果有积极影响，因此提倡积极的生活方式是合理的。性行为与 PCa 的相互作用的证据最少，显然需要进行精心设计和纵向研究，以评估 PCa 风险与性行为之间建议的关联是真实的还是虚假的。
在这项系统评价中，我们研究了吸烟、性行为和体育锻炼对前列腺癌风险和治疗后结果的影响。虽然性行为的证据总体上并不明确，但我们发现吸烟可能导致更具侵袭性的癌症，并导致更差的治疗结果。身体活动可能预防前列腺癌并改善与癌症相关的结局。因此，提倡积极的生活方式并建议男性戒烟是合理的。
