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Association Between Alcohol Intake and Prostate Specific Antigen Screening: Results from a National Behavioral Survey - Beyond the Abstract

Alcohol use disorder is a public health problem affecting 12% to 14% of adults in the U.S.1 The link between excessive alcohol intake and higher risk of developing cancer has been established for several tumors such as oral, esophageal, breast, pancreas, and colorectal cancer.2 Moreover, recent studies have suggested an association between heavy drinking and higher risk of prostate cancer and worse cancer outcomes.3–5

In the setting of a potential role of excessive alcohol use in cancer pathogenesis and in worse prostate cancer outcomes, we sought to determine whether prostate cancer screening differed among men who report both higher alcohol intake as well as a history of binge drinking. The Centers for Disease Control definitions for binge and heavy drinking for men were utilized (5 or more drinks per sitting, and 14 or more drinks per week, respectively). We found that there was significantly lower use of PSA screening in heavy drinkers (OR 0.84, 95% CI 0.72 – 0.98, p=0.023) but not among binge drinkers ((OR 0.96, 95% CI 0.86 – 1.07, p=0.46).6

Our results have direct policy implications. Guidelines recommend (grade C) PSA screening in men aged 55 to 69 after discussing the possible benefit and harm. Since heavy drinkers are less likely to undergo PSA screening and there is evidence suggesting a higher risk of prostate cancer among those men, these men represent a comparatively high-risk group.

Despite the inherent limitations of retrospective survey-based research, the current findings have important implications. This is the first national survey-based study that directly investigates the association between alcohol consumption and prostate cancer screening. Efforts to investigate and intervene upon barriers to guideline-concordant PSA screening among heavy drinkers and other at-risk populations should be encouraged. These programs may aid in prostate cancer detection and early treatment for these vulnerable groups of men.

Written by: Nicola Frego, MD, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

References:

  1. Edelman EJ, Fiellin DA. Alcohol Use. Annals of Internal Medicine. 2016;165(5):379. doi:10.7326/L16-0107
  2. Center for Behavioral Health Statistics S, International R. NATIONAL SURVEY ON DRUG USE AND HEALTH 2014 AND 2015 REDESIGN CHANGES.; 2015.
  3. Gong Z, Kristal AR, Schenk JM, Tangen CM, Goodman PJ, Thompson IM. Alcohol consumption, finasteride, and prostate cancer risk: Results from the prostate cancer prevention trial. Cancer. 2009;115(16):3661-3669. doi:10.1002/cncr.24423
  4. Zuccolo L, Lewis SJ, Donovan JL, Hamdy FC, Neal DE, Smith GD. Alcohol consumption and PSA-detected prostate cancer risk - A case-control nested in the ProtecT study. International Journal of Cancer. 2013;132(9):2176-218
  5. Zhao J, Stockwell T, Roemer A, Chikritzhs T. Is alcohol consumption a risk factor for prostate cancer? A systematic review and meta-analysis. BMC Cancer. 2016;16(1). doi:10.1186/s12885-016-2891-z
  6. Frego N, Alkhatib K, Labban M, et al. Association Between Alcohol Intake and Prostate Specific Antigen Screening: Results from a National Behavioral Survey. Urology. Published online June 2022. doi:10.1016/j.urology.2022.06.008

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