Drinking from an early age linked to aggressive prostate cancer later in life

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A study out of the University of North Carolina at Chapel Hill has found a link between early-life alcohol consumption and aggressive, high-grade prostate cancer. The study also found that heavy cumulative alcohol consumption over the course of a man’s life had a similar association with this type of prostate cancer.

“There’s been relatively little progress in identifying risk factors for prostate cancer,” said Emma Allott, senior author for the study. “Other hormonally regulated cancers, like breast cancer, already have a known association with alcohol use. But the role that alcohol consumption may have in the development of prostate cancer, especially over the life course, isn’t as well understood, so it remains an important area of study.”

Allott led the research, along with her collaborators, while she was an assistant professor of nutrition in the Gillings School of Global Public Health at UNC-Chapel Hill. Allott has since joined Queen’s University Belfast as a lecturer in molecular cancer epidemiology at the Centre for Cancer Research and Cell Biology.

The team of researchers evaluated survey data obtained from 650 men at the time of prostate biopsy. Men who reported consuming more than seven alcoholic drinks weekly as teenagers between the ages of 15 and 19 were three times more likely to be diagnosed with high-grade prostate cancer compared with men who reported no alcohol use during these years. Men who had seven or more alcoholic beverages a week throughout each decade of life were also three times more likely to be diagnosed with high-grade prostate cancer at the time of biopsy.

Prostate cancer is the most commonly diagnosed non-skin cancer in US men and the second leading cause of male cancer deaths. The prostate develops rapidly during puberty and, as a result, scientists have hypothesised that boys may be more susceptible to cancer-causing substances during their adolescent years.

“We think that prostate cancer develops over the course of many years or even decades, so studies like ours are working toward a clearer understanding not only of what the specific risk factors are, but how they may affect prostate biology at different stages of life,” said Allott.

Not all prostate cancers are high-grade, or the clinically significant, aggressive form of prostate cancer that grows quickly and can potentially lead to death. The researchers sought to investigate the potential relationship between early-life alcohol consumption and high-grade, prostate cancer, believing that it’s most important to identify risk factors for the aggressive form of the cancer. The researchers did not find an association between alcohol use and other less aggressive forms of prostate cancer.

Allott and her team evaluated survey data from a group of racially diverse men, ages 49-89 years, undergoing prostate biopsy at the Durham Veterans Affairs Medical Centre between 2007 and 2018. Men completed a survey to assess the average number of alcoholic beverages consumed weekly during each decade of life, categorising this as zero, one to six, or seven or more drinks each week to determine age-specific and cumulative lifetime alcohol intake.

The research was limited by its reliance on men’s recall of their historic alcohol intake. This could have resulted in biased responses, although the majority of men reported their alcohol intake prior to knowing their biopsy results. Additional research is needed to determine the risk factors for prostate cancer.

Allott’s research collaborators included Jamie Michael, Amanda De Hoedt and Charlotte Bailey of Durham Veterans Affairs Medical Centre, Lauren Howard of Duke Cancer Institute, Sarah Markt and Lorelei Mucci of Harvard University, and Stephen Freedland of Durham Veterans Affairs Medical Centre and Cedars-Sinai Medical Centre.

The research was funded by the American Institute for Cancer Research, the Irish Cancer Society and the National Institutes of Health.

 

But experts agreed that this one study isn’t enough to suggest new recommendations regarding alcohol consumption, reports Reuters Health. “If I am a sober person who drank heavily in my youth, I wouldn’t worry too much,” said Dr Christopher Saigal of the University of California – Los Angeles Jonsson Comprehensive Cancer Centre, who wasn’t involved in the research. “The study has limitations. For one thing, it’s an association (rather than proof of cause). Also, they didn’t find that alcohol raised the risk of prostate cancer, but instead, that a subset of men might be at risk for high-grade disease.”

The study wasn’t large enough for the researchers to be able to tell whether men’s drinking styles – whether consuming a drink or two each day or bingeing on the weekends – had an impact, noted Dr Anne McTiernan of the Fred Hutchinson Cancer Research Centre in Seattle, Washington. “But it gives a hint at the high relative risks of alcohol exposure,” said McTiernan, who wasn’t involved in the study. “The bottom line, I would say, is that you should minimise alcohol intake just as we do with many other cancers. Most organisations say that for men you should have no more than two drinks a day. If you’re concerned about cancer risk, maybe that should be even lower.”

There are plenty of other reasons young men shouldn’t be drinking on a daily basis, said Dr Leonard Appleman of the University of Pittsburgh Medical Centre in Pennsylvania in the report. “But this is another example of chronic alcohol consumption’s long-term impact in many areas.” The fact that current drinking wasn’t associated with high grade tumours, “fits in with what we know about prostate cancer. It’s decades in the making. The mutations start in early adulthood and build up over the decades.”

Abstract
Epidemiologic evidence for an association between alcohol and prostate cancer is mixed. Moreover, there is a lack of research investigating early-life alcohol intake as a risk factor for either overall or high-grade prostate cancer. We examined lifetime alcohol intake in association with prostate cancer diagnosis in an equal-access, racially diverse prostate biopsy cohort. Men undergoing prostate biopsy at the Durham Veterans Affairs Medical Center from 2007 to 2018 completed a survey indicating average number of alcoholic beverages consumed per week [categorized as none (ref), 1–6, ≥7] during each decade of life. Multivariable logistic regression was used to test the association between alcohol intake across decades and diagnosis of overall, low-grade [grade group (GG) 1–2] and high-grade prostate cancer (GG 3–5). Of 650 men ages 49–89 who underwent biopsy, 325 were diagnosed with prostate cancer, 238 with low-grade and 88 with high-grade disease. Relative to nondrinkers, men who consumed ≥7 drinks/week at ages 15 to 19 had increased odds of high-grade prostate cancer diagnosis (OR = 3.21, P trend = 0.020), with similar findings for ages 20 to 29, 30 to 39, and 40 to 49. Consistent with these results, men in the upper tertile of cumulative lifetime intake had increased odds of high-grade prostate cancer diagnosis (OR = 3.20, P trend = 0.003). In contrast, current alcohol intake was not associated with prostate cancer. In conclusion, among men undergoing prostate biopsy, heavier alcohol intake earlier in life and higher cumulative lifetime intake were positively associated with high-grade prostate cancer diagnosis, while current intake was unrelated to prostate cancer. Our findings suggest that earlier-life alcohol intake should be explored as a potential risk factor for high-grade prostate cancer.

Authors
Jamie Michael, Lauren E Howard, Sarah C Markt, Amanda De Hoedt, Charlotte Baily, Lorelei A Mucci, Stephen J Freedland and Emma H Allott

University of North Carolina at Chapel Hill material
Reuters Health report
Cancer Prevention Research abstract


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