Is a Few Too Many? Alcohol Consumption and Prostate Cancer Upgrading During Active Surveillance

The association between alcohol consumption and prostate cancer (PCa) outcomes remains mixed, with particularly limited data on the association between alcohol consumption and risk of upgrading among men undergoing active surveillance (AS).

We analyzed men with Grade Group (GG) 1 PCa managed in a prospectively maintained AS cohort who, at the time of AS enrollment, completed a questionnaire assessing average weekly alcohol consumption during the 5 years preceding PCa diagnosis. Alcohol intake was categorized as < 1, 1-6, and ≥ 7 drinks per week. Multivariable competing risk regression was used to evaluate self-reported alcohol intake for association with any upgrading (to ≥ GG2) and extreme upgrading (to ≥ GG3) on surveillance biopsy, adjusting for baseline clinicopathological factors, smoking, self-reported race, and body mass index.

A total of 1506 men were included. After a median follow-up of 3.5 years (quartiles 1.6-6.2) from confirmatory biopsy, 527 men experienced upgrading, including 166 with extreme upgrading. In multivariable regression models adjusted for covariates, higher baseline alcohol consumption was associated with increased risk of upgrading to ≥ GG2 (p-value for linear trend 0.003). Compared with < 1 drink per week, consumption of ≥ 7 drinks per week was associated with a 51% higher risk of upgrading to ≥ GG2 (subdistribution hazard ratio 1.51, 95% confidence interval 1.19-1.90). In a sensitivity analysis, each additional drink per week was associated with a 4% higher risk of upgrading (SHR 1.04, 95% CI 1.02-1.06). Alcohol consumption was not associated with extreme upgrading.

In a large prospective cohort of men undergoing AS, higher baseline self-reported alcohol consumption was associated with upgrading to ≥ GG2 on surveillance biopsy. No association was observed with extreme upgrading. These findings may inform clinical counseling regarding alcohol use during AS, although further studies are needed to validate our findings.