Teenage tippling tied to high-grade prostate cancer

Heavier alcohol consumption in adolescence may predict later high-grade prostate cancer diagnosis, according to a new study published in Cancer Prevention Research.

“The prostate undergoes significant growth and maturation during puberty, so presumably, during this period it might be particularly susceptible to carcinogenic exposures,” wrote senior author Emma H. Allott, PhD, Department of Nutrition, University of North Carolina at Chapel Hill, NC, and colleagues. “As such, consideration of early-life exposures may be important for understanding prostate cancer etiology.”

The association between alcohol consumption and prostate cancer is contentious, with research findings mixed. Alcohol intake, however, has been linked to female breast, colorectal, oral cavity, liver, esophagus, larynx, and pharynx cancers.

In this study, researchers assembled a prostate biopsy cohort of 650 veterans (47% Caucasian) who underwent prostate biopsy between 2007 and 2018. Subjects had no previous history of prostate cancer and ranged in age from 49 to 89 years. Following biopsy, participants were asked to fill out a questionnaire that detailed demographic, medical, and lifestyle, including ranges of average weekly alcohol intake during each decade of life.

The primary exposure was mean number of drinks consumed between the ages of 15 to 19 years. The team also assessed such intake at 20-29, 30-39, and 40-49 years, as well as current and lifetime alcohol consumption. For analysis, average consumption was broken down to zero alcoholic drinks per week, 1-6 alcoholic drinks per week, and ≥ 7 drinks per week. Of note, the researchers did not distinguish type of alcohol consumed or serving size.

Researchers used logistic regression to assess the association between alcohol consumption and prostate cancer diagnosis during biopsy. They adjusted models for age, race, digital rectal exam results, prostate-specific antigen at biopsy, prostate volume, biopsy year, cigarette pack-years, previous prostate biopsy, and body mass index.

In all, 49% reported abstinence from alcohol during ages 15-19 years, 43% reported drinking 1-6 drinks per week, and 8% reported drinking ≥ 7 drinks per week. Of note, participants who drank ≥ 7 drinks per week from ages 15 to 19 years exhibited higher cigarette pack-years (P < 0.001), with other characteristics similar among groups.

In total, 325 of 650 men were diagnosed with prostate cancer. Compared with nondrinkers, men who drank ≥ 7 alcoholic drinks per week from 15 to 19 years of age had higher odds of high-grade cancer diagnosis (OR: 3.21; P_trend=0.020), with similar results observed in other decades of life. Additionally, men in the highest tertile of lifetime alcohol consumption also demonstrated heightened odds of high-grade prostate cancer (OR: 3.20; P_trend=0.003). Of note, the researchers discovered no correlation between current drinking patterns and prostate cancer diagnosis.

The investigators hypothesized that chronic alcohol consumption could heighten cancer risk by enhancing the activation of carcinogens—including acetaldehyde, ethanol, and formaldehyde—by means of an ethanol-inducible cytochrome P450 enzyme.

The authors acknowledged that recall bias could have confounded the study results as study participants were asked to self-report alcohol intake.

“Our results may explain why previous evidence linking alcohol intake and prostate cancer has been somewhat mixed," stated Dr. Allott. “It's possible that the effect of alcohol comes from a lifetime intake, or from intake earlier in life rather than alcohol patterns around the time of diagnosis of prostate cancer.”

This study was funded by the American Institute for Cancer Research, the Irish Cancer Society John Fitzpatrick Fellowship, and the National Institutes of Health.