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

Men with favorable-risk prostate cancer (PCa) undergoing active surveillance (AS) often seek lifestyle modifications that may reduce their risk of disease progression. We assessed the association between alcohol intake and biopsy upgrading during AS. In this prospective observational study, we included 1,505 men (median follow-up 3.5 years) who were diagnosed with grade group (GG) 1 PCa during 2005–2023 and upon AS enrollment completed a questionnaire estimating alcohol consumption during the preceding 5 years, which we categorized as <1, 1-6, and ≥7 drinks per week. Multivariable competing risk proportional hazards regression was utilized to evaluate self-reported alcohol intake for association with upgrading to ≥GG2 and extreme upgrading to ≥GG3 on a surveillance biopsy, adjusting for baseline clinicopathological prognostic factors, smoking history, and body mass index. Increased alcohol consumption was positively associated with upgrading to ≥GG2 (p¬ for linear trend = 0.008). Compared to <1 drink per week, consumption of ≥7 drinks per week was associated with a 47% increase in the risk of upgrading (subdistribution hazard ratio 1.47, 95% confidence interval 1.16–1.85). No significant association was found between alcohol consumption and extreme upgrading. Our findings identify alcohol consumption as a potentially modifiable lifestyle factor associated with upgrading during AS.