To identify phenomena that might explain a higher mortality-to-incidence ratio for prostate cancer among smokers, 359 patients with newly diagnosed tumors at a community hospital were analyzed by tumor stage and grade, host age, obesity, smoking habits and survival. Among the 235 men with nonstage A tumors, stage D disease was independently related to host smoking (odds ratio 2.1, 95% confidence interval 1.3 to 4.3, p = 0.015), as well as to higher tumor grade, younger host age and lack of obesity. Stage D disease was present in 69% of 16 heavy smokers, 41% of 44 other smokers and 31% of nonsmokers. The 5-year tumor-specific mortality rate was greater among smokers than nonsmokers with stage D2 disease (88% versus 63%, p < 0.05) or with nonstage A disease (39% versus 17%, p < 0.001). These observations are compatible with earlier metastasis and more aggressive subsequent tumor advancement in smokers, and indicate that smoking habits may contribute to differences in prostate cancer prognosis between populations.