An occasional series on the environment: LA & Canada are burning. Wildfire links to PCa

O Canada ... O California. Urban-natural "interface" taking a toll in the Bear Republic.

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By Howard Wolinsky

In 2023, Canada was hit by the most destructive wildfire season in its history.

By the end of the year, more than 6,000 fires had torched a staggering 15 million hectares (37,00 acres) of land—an area larger than England and more than double the previous record in 1989. Some of those fires are still smoldering in peat moss as they overwinter and will make a comeback in 2025 as they did in 2024. They’re called”zombie” fires.

You may remember that the original blazes darkened your skies and worsened your air quality. These Canadian fires impacted the Midwest and the Northeast in the U.S.

Some days in 2023, Chicago had the dirtiest air anywhere on the planet. I stayed inside on those days and took a pass on my usual five-mile walks in the woods in a nearby nature preserve.

As the South Park guys said in their song “Blame Canada.”

I stopped in my tracks back then when I read in the New York Times that among the long-term effects of the smoke was an increase in prostate cancer.

So faraway from the blazes in Canada, down below the 49th parallel, smoke has been seeding future cancer deep in the prostates of men in the City of Big Shoulders and the Big Apple, and in between.

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Flash forward to today to Tinseltown and environs.

(USDA)

Bottom line: The fires in LA are expected in the years ahead to be associated with prostate cancer in LA’s many male residents and also male firefighters.

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The real surprise for me came from that New York Times article suggesting reported wildfires are linked to prostate cancer.

Huh?

Ok, I can see how respiratory cancers and diseases like asthma and COPD could be linked. But how does carcinogenic smoke reach the prostate, which is situated beneath the bladder and in front of the rectum?

Cancer has its ways as we well know.

Urologist Alexander Putnam Cole, MD, an environmental and prostate researcher and urologist at Harvard Medical School, confirmed the wildfire-prostate cancer link.

He said LA area residents and firefighters also are at risk.

The wildfires that simmered for 24 days in January in Los Angeles had the immediate impact of killing 29 people, triggering respiratory disease such as asthma and longer- term health problems and destroying 17,000 homes, warehouses, businesses and other structures.

Cole told me prostate cancer in the years ahead will be part of the burden of disease coming out of the LA fires, too. This includes local residents and especially firefighters, who long have been known to have an increased occupational risk of prostate cancer because of increased exposure to carcinogenic combustion products (e.g. polycyclic aromatic hydrocarbons and particulate matter) as well as some carcinogens within firefighting chemicals.

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I can understand how lungs are affected. But the isolated, protected prostate? Really?

Cole said: “There are links between forest fires and prostate cancer. And they're links on multiple different levels. Very basic forest fires create fine particulate pollution, which is linked to a number of cancers, including prostate cancer.”

(Urologist Dr. Alexander P. Cole, Harvard environmental health expert.)

He has just published a paper in the journal Nature Reviews Urology entitled “Urology on a changing planet: links between climate change and urological disease.

“Typically people [in this case] don’t think about prostate cancer. They do think about lung or pharyngeal cancer, but there are links to prostate cancer. They're not quite as robust, but they are there.”

Cole said groundwater is a likely source of prostate cancer: “An area where you might see more cases prostate cancer is when you have endocrine-disrupting chemicals associated with industrial sites, which then get flooded. The end product ends up in groundwater on agricultural sites. That's, I think, a closer pathway to prostate cancer.”

The LA wildfires had an extra-nasty feature—they turned into urban fires as homes, cars and other manmade materials burned and released other carcinogenic chemicals.

Millions of Angelenos were exposed to particulate matter, gases, chemicals, heavy metals, asbestos, PFAS, microplastics, and other toxic pollutants. The chemicals settle out of the air into soil and dust and can become resuspended during recovery and rebuilding efforts. Water quality can also be affected.

Cole said: “Wildfire-associated pollution is likely associated with prostate cancer incidence and mortality. This is due to fine particulate pollutants as well as combustion byproducts. I think the risk may be particularly large at the urban/wildfire interface. Specifically, firefighting has long been recognized as an occupational carcinogen.”

“Most importantly wildfires expose nearby individuals to carcinogenic combustion byproducts as well as particulate air pollution that has been linked to prostate cancer. In addition, wildfires are linked to changing land use and loss of greenspace. We know that there is a lower risk of prostate cancer in areas with more greenspace.

“The reasons for this are still being worked out but might include changes in epigenetic aging, reduced physical and psychosocial stress and differences in inflammation.”

Cole and his colleagues wrote that the three most common urological cancers “might be linked to climate change: air pollution, wildfires and drinking water. These exposure pathways were chosen because epidemiological data indicate a growing consensus on the carcinogenic potential of these exposures and they have clear connections to climate change^.”

They note that in Brazil, wildfire-associated fine particulate matter (PM_2.5) concentrations have been shown to have a significant association with prostate cancer mortality. Wildfire-associated fine particulate matter was associated with prostate cancer mortality, with about a 3% increase in mortality for every 0.019 microgram per cubic meter of wildfire-associated fine particulate matter.

“Furthermore, among patients with prostate cancer, evidence suggests elevated risks of cardiopulmonary mortality associated with increased exposure to PM_2.5. This finding is noteworthy given that many patients with prostate cancer will ultimately die from concomitant cardiopulmonary disease.”

The International Agency for Research on Cancer (IARC), part of the (defunded) World Health Organization researches the causes of cancer and develops strategies to control them. The IARC designated firefighting as potentially carcinogenic, with limited evidence for prostate cancer.

Cole et al. noted: “In a Swedish study including 8,136 male firefighters, risk of prostate cancer was increased in those with ≥30 years of employment … which is suggestive of a dose–response gradient supporting the association between years of firefighting and prostate cancer.”

Cole said natural disasters such as hurricanes and wildfires are associated with damage to infrastructure and industrial sites which may lead to carcinogenic chemicals entering the soil and water supply.

“Lastly, you need to consider the impact of natural disasters on health-care delivery. We know that events like hurricanes are associated with changes in cancer mortality likely due to interruptions in care.”

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Check out my new Substack newsletter Prostate Cores, abstracts on research on PCa, biopsies, BPH, prostatitis.

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Harvard Medical School is joining with other institutions to follow the health impacts of the wildfire. The study is called Los Angeles Fire Human Exposure and Long-Term Health Study (L.A. Fire HEALTH Study) that will examine pollutants are present, at what levels, where, and how they change over time; and determine if the fires and aftermath are associated with chronic health effects in the nearby population.

In the study’s first phase, teams are mapping and understanding exposures during the fires, including emissions from the burning of vegetation and buildings and the composition of pollutants in the wildfire smoke. As part of the air sampling effort, a mobile van will be deployed, equipped with advanced measurement technologies that can measure the chemical composition of particulate matter and gases in real time.

“This was an environmental and health disaster that will unfold over decades,” said Kari Nadeau, MD, chair of the Department of Environmental Health at Harvard Chan School, professor of medicine, Harvard Medical School, and an allergist and asthma expert at Beth Israel Deaconess Hospital.

Cole concluded: “We know that with the changing planet, natural disasters like wildfires are going to become both more common and more severe.”

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Congrats rolling in on the 3rd Anniversary of The Active Surveillor

Jeffery Coleman, Eldersburg, Maryland: Congrats on your 3rd anniversary Howard! Thanks for a great 3 years of information and hope many more to follow. Here's hoping also that more people become paid subscribers, it's certainly worth every penny.

MW, Denver, Colorado: I dated a Jewish doctor a long time ago. She told me a Jewish adage that ‘... saving one life is saving mankind.’ I am sure that you've saved many men from unnecessary, heart-breaking miseries all these years. Bravo to you, my Stoic friend.

Harley Myler, Wilmington, North Carolina: Congrats, Howard! Very, very good work and an asset to the community.

David Keller, Jacksonville, Florida: Congratulations!! We are 477 times smarter than we were before your newsletter. (This is is the 478th edition.)

Charles Brown III, Glenn Ellyn, Illinois: Congrats on the 4777 issues published!! That is so awesome! It was good to see the history of how you got to where you are today. This was so heartening to read. I continue to promote your site!

Fred Pieplow, St. Joseph, Michigan: Well done, Howard. Your hard work has touched a lot of men and care givers and given them encouragement along with great information, including me.

Richard Mayer, Columbus, Ohio: Congratulations on your three-year anniversary for your newsletter. It has helped so many of us with PCa gain an improved understanding of this disease.

Dr. Perry Yap, Quezon City, the Philippines. Congratulations and more power to you. Thanks.

PAUL SCHELLHAMMER, MD, urologist, urology professor, past president, American Urological Association:

—Thanks to you all, HW. I couldn’t do The Active Surveillor without you.

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Don’t miss the upcoming ASPI webinar on AS and Gleason 3+4=7

By Howard Wolinsky

Kevin Ginsburg, MD, urologic oncologist at the Karmanos Cancer Institute/Wayne State University in Detroit, will be presenting a webinar for Active Surveillance Patients International (ASPI) entitled “Is favorable intermediate-risk PCa the future of AS?"

The program will be held from —12-1:30 pm Eastern, Saturday, Feb. 22. Celebrate President George Washington’s birthday with ASPI.

To register, go to: https://aspatients.org/event/is-favorable-intermediate-risk-pca-the-future-of-as/

Ginsburg is J. Edson Pontes, M.D., Distinguished Endowed Chair in Men's Health at Wayne State and co-director of the MUSIC prostate program.

(Dr. Kevin Ginsburg, co-director of the very successful MUSIC program in Michigan.)

MUSIC (Michigan Urological Surgery Improvement Collaborative) has been one of the most successful U.S. programs for Active Surveillance. Over 90% of patients with low-risk prostate cancer in its program go on AS vs. 60% nationally. Likewise, MUSIC has been successful in offering AS to patients with favorable intermediate-risk prostate cancer at a rate of about 45% compared with 20% nationally.

In 2023, ASPI presented MUSIC with its first ASPI AS ADVOCACY AWARD for its advances in researching and promoting Active Surveillance for lower-risk patients in place of aggressive treatments.

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“Typically people [in this case] don’t think about prostate cancer. They do think about lung or pharyngeal cancer, but there are links to prostate cancer. They're not quite as robust, but they are there.”

Cole said groundwater is a more likely source of prostate cancer. An area where you might see that more in prostate cancer is when you have endocrine-disrupting chemicals associated with industrial sites, which then get flooded. The end product ends up in groundwater on agricultural sites. That's, I think, a closer pathway to prostate cancer.”