CIGARETTE-SMOKING AND PROSTATISM - A BIPHASIC ASSOCIATION

Objective. To evaluate the association between cigarette smoking and p rostatism in a community-based setting using standardized urinary symp tom scores, peak urinary flow rates, and prostatic volume as indicator s of disease. Methods. A population-based cohort of 2,115 Caucasian me n aged forty to seventy-nine years from Olmsted County, Minnesota, was administered a previously validated questionnaire that elicited infor mation on frequency of urinary symptoms (approximating the American Ur ological Association's symptom index), and a detailed history on cigar ette smoking, including both amount and pack-years of smoking. Peak ur inary flow rates were measured by a standard uroflowmeter (Dantec 1000 ). The prostatic volume was measured for a subsample of 471 men by tra nsrectal ultrasound. Results. Compared to never-smokers, smokers were less likely to have moderate to severe urinary symptoms (age-adjusted odds ratio 0.82; 95% confidence interval [CI] 0.61 to 1.08). This vari ed by smoking intensity, however; in men who smoked less than 1 pack a day the age-adjusted odds ratio was 0.53 (95% CI 0.33 to 0.83) and am ong men smoking 1 to 1.4 packs a day, the odds ratio was 0.87 (95% CI 0.56 to 1.36). For men who smoked 1.5 packs or more a day, the odds ra tio was elevated at 1.32 (95% CI 0.84 to 2.07). Smokers were less like ly to have peak flow rates less than 15 mL/sec compared with never-smo kers (age- and voided volume-adjusted odds ratio 0.48; 95% CI 0.35 to 0.66), or prostatic volume greater than 40 mL (odds ratio 0.54; 95% CI 0.19 to 1.55). Conclusions. These data from a community-based sample suggest that light or moderate smokers are less likely to have moderat e to severe prostatism, whereas heavy smokers are at least as likely t o have moderate to severe prostatism compared with never smokers.