Article - Association between Alcohol Intake and Prostate Cancer Mortality and Survival.

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Take home message

For those mindful of PCa outcomes, a reduction in alcohol consumption may lower the risk of PCa fatality.

Evidence category

A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)

Summary review

Introduction

Prostate cancer (PCa) is the second most common cancer worldwide. ranked fifth in causes of mortality.
Mortality in cancer patients has been associated with alcohol consumption, although evidence is limited and often focuses on the association with PCa risk.
This systematic review and meta-analysis aimed to evaluate the association between alcohol consumption and mortality and PCa related outcomes, in order to update and support recommendations in the management of alcohol consumption in PCa patients.

Methods

The selection of articles for inclusion used PECO.
The systematic review followed PRISMA guidelines and was registered on Open Science Framework.
Literature searching resulted in 19 prospective, observational studies with 80% cohort-study designs published between 1990-2022, which evaluated the association between alcoholic consumption and risk of fatal PCa (n=5), PCa mortality in healthy subjects (n=5), PCa survival (n=7) or clinical surrogates (n=2).
Meta-analysis used random-effect model with summary risk estimates (SRE’s) and 95% CI’s for the correlation between high and low alcohol consumption.
Overall study quality was rated as generally fair.

Results

No association of alcohol consumption was found with fatal PCa incidence risk in healthy subjects with an indication of publication bias.
With results from Watters et al. (2010) omitted, the SRE became significant (SRE 1.33, 95% CI 1.12–1.58), and heterogeneity disappeared (I2 = 0%) with no indication of publication bias.
No association of alcohol consumption was found with mortality risk in PCa patients (SRE 0.97, 95% CI 0.92–1.03) (I2 = 13.8%).
No association of alcohol consumption was found with mortality risk in PCa in healthy subjects (SRE 1.03, 95%CI 0.82–1.30) with high consistency across studies (I2 = 0%).

Discussion

This study reports some evidence of a relationship between high alcohol consumption and an increased risk of fatal PCa in healthy subjects.
Limitations include low number of available studies, missing information and methodological inconsistencies leading to high heterogeneity.
Future research is needed with robust study designs to measure dose-response relationships of alcohol and PCa outcomes

Clinical practice applications

Whilst adhering to BANT guidelines to support safe practice when interacting with individuals with a confirmed or suspected cancer diagnosis, NT and other clinicians need to be aware of the evidence that alcohol consumption may be a risk factor for fatal PCa and recommend accordingly.
Lack of other associations of alcohol consumption and PCa outcomes may be a result of the study limitations, therefore until further studies have been completed, a cautious approach to alcohol consumption would be prudent.

Considerations for future research

Development of more robust instruments to measure alcohol consumption in PCa outcomes is important.
Well-conducted research is needed to evaluate dietary intake, supplements and other lifestyle factors in PCa prognosis.
Broadening similar research to include other very common cancers eg breast and colorectal.

Abstract

We conducted a systematic review and meta-analysis to investigate the role of alcohol consumption with the prognosis of prostate cancer (PCa). Published reports were gathered on 15 October 2022, from PUBMED/MEDLINE and EMBASE. We found 19 independent eligible studies on the association between consumption of alcoholic beverages and the risk of fatal PCa (n = 5), PCa mortality (n = 5) in healthy subjects, and PCa patients' survival (n = 7) or surrogates thereof (n = 2). We used random effects meta-analysis to obtain a summary risk estimate (SRE) and 95% confidence intervals (95%CI) for incidence of fatal PCa and PCa mortality. The meta-analysis revealed no association between alcohol consumption and fatal prostate cancer incidence risk in healthy subjects with an indication for publication bias, but omitting the study that mainly increased the between-study heterogeneity, the SRE becomes significant (SRE 1.33, 95%CI 1.12-1.58), and the heterogeneity disappeared ( = 0%) with no indication of publication bias. No association of alcohol consumption was found with mortality risk in PCa patients (SRE 0.97, 95%CI 0.92-1.03) and PCa mortality risk in healthy subjects (SRE 1.03, 95%CI 0.82-1.30). In conclusion, this study suggests that there is some evidence of an association between high alcohol consumption and an increased risk of incidence of fatal prostate cancer in healthy subjects. Given the inconsistencies this result warrants further confirmation.