Medical Management of Benign Prostatic Hyperplasia (BPH) - UCLA Urology
Background Although many studies suggest that consumption of alcohol increases the risk of several site-specific cancers, the evidence alcool BPH unclear for prostate cancer. Few data exist on beverage-specific associations as well as lifetime patterns alcool BPH alcohol consumption and prostate cancer risk. Methods We prospectively followed Harvard alumni alcool BPH age Self-reported alcohol consumption was assessed at baseline from wine, beer, and liquor intake. Previous assessments during college and in were also available.
Results Overall, the mean total alcohol consumption in was Men initiating alcohol consumption between and alcool BPH a twofold increased risk of prostate cancer compared to men with almost no alcohol consumption at both times.
Conclusions In contrast to the majority of previous studies, we found a positive association between moderate alcohol consumption and the risk of prostate cancer. Liquor, but not wine or beer, consumption was positively associated with prostate cancer. A recent review of epidemiological studies on alcohol alcool BPH and prostate cancer risk concluded that the available evidence shows no apparent increased risk among light-to-moderate alcool BPH.
Few data exist regarding beverage-specific effects. Alcohol may increase prostate cancer risk through several proposed mechanisms, including increased levels of plasma sex hormones, immunosuppression, or activation of carcinogenic metabolites. We therefore examined the association of total and beverage-specific alcohol consumption with prostate cancer risk using data alcool BPH the Harvard Alumni Study, a prospective cohort study of middle-aged and older men.
In addition, we sought to investigate whether lifetime patterns of alcohol consumption were associated with the risk of prostate cancer. The Harvard Alumni Study is an ongoing cohort study of the predictors of chronic diseases in alcool BPH matriculating as undergraduates at Harvard University between alcool BPH We first mailed alcool BPH health questionnaire to surviving alumni in either orthen periodically sent questionnaires to all surviving alumni in the relevant classes to update information on health habits and medical history.
For this study, we were interested in information from a mailed questionnaire in Of 12 men returning the questionnaire, we excluded alcool BPH reporting any history of physician-diagnosed cancer, men with incomplete data on alcohol consumption, and men with missing alcool BPH on other potential risk factors for prostate cancer. Of the remaining men, we successfully followed i.
To assess alcohol consumption inwe alcool BPH alumni to report their intake of wine, beer, and liquor or spirits, e. We estimated total alcool BPH consumption alcool BPH summing wine, beer, and liquor intake using the midpoints of the first six responses with values of 0, 0.
Self-reports of alcohol intake using food frequency questions are reasonably reliable alcool BPH valid, as indicated by previous studies of alcool BPH health professionals and population-based groups.
Alcohol consumption from the college physical exam was measured from an alcool BPH question without regard to specific beverage intakes. On the questionnaire, we also asked alumni to report the daily number of flights of stairs climbed and city blocks walked, as well as to list all sports or recreational activities in which they had actively participated during the past year.
From these data, we estimated total energy expenditure. We ascertained cases of prostate cancer through self-reports on the follow-up questionnaire sent in The date of diagnosis was taken as the reported year of diagnosis. We traced deaths through the end of For each death reported by the alumni office, we requested and obtained death certificates from the appropriate state. We included as prostate cancer endpoints deaths with alcool BPH cancer listed as either the underlying or a contributing cause of death.
We first examined the distribution of baseline characteristics according to categories of alcohol consumption. We calculated person-years of follow-up from to the year in which prostate cancer was first reported, the year of death, orwhichever occurred first.
Models were first adjusted for age, and multivariate models were further adjusted for the non-dietary risk factors described above. A second multivariate model was further adjusted for the dietary factors described above that may confound the association between alcohol consumption and the risk of prostate cancer. Tests for linear trend treated the five categories of alcohol consumption as a single ordinal variable, using the median values for each category.
Alcool BPH then tested for the presence of non-linear trends with the addition of both the ordinal term and the square of the ordinal term in the model. Parallel analyses were performed for each alcool BPH beverage type. In secondary analyses, we excluded men with prostate cancer during the first 2 years of follow-up to minimize any bias due to illnesses that alcool BPH have affected baseline alcohol consumption.
We also examined whether the exclusion of men with prevalent cardiovascular disease on the questionnaire alcool BPH any of the results. Subjects in the present study had been alcool BPH additionally about alcohol consumption in the past at their alcool BPH physical examination and on a questionnaire mailed in We examined men Alcohol consumption was initially cross-classified using the five categories of intake from each questionnaire, then categories were collapsed a priori to improve power since few men reported large changes in alcohol consumption from the to questionnaires.
We then identified men The mean standard deviation age of the men at baseline in was Overall, the mean total alcohol consumption in was Although a similar number of men consumed wine or liquor, wine alcool BPH was more alcool BPH whereas liquor consumption was heavier. Table 1 alcool BPH data on the baseline characteristics according to levels of alcohol consumption in Men who almost never drank alcohol tended to be older, consume more vegetables, and take vitamins or supplements.
Men alcool BPH consumed greater amounts of alcohol tended to have higher physical activity levels, yet were more likely to be current or former smokers and consume more red meat. During a median follow-up of 5. Table 2 provides the results for the association between total alcohol, wine, beer, and liquor consumption and the risk of prostate cancer. Age was the strongest confounder in all models of alcohol consumption and the risk of prostate cancer.
Additional adjustment for potential confounders alcool BPH body mass index, physical activity, cigarette smoking, and parental history of cancer had a nominal effect on the observed RR. In sensitivity analyses, adjustment for history of hypertension, diabetes, or cardiovascular disease did not appreciably alter alcool BPH RR.
Finally, the exclusion of men with alcool BPH cancer during the first 1, 2, or 3 years of follow-up resulted in no difference for alcool BPH RR data not alcool BPH. Excluding men with prevalent cardiovascular disease at baseline slightly increased the magnitude of the RR for increasing total alcohol consumption to 1.
We also considered deciles of total alcohol consumption estimated from wine The pattern of RR for increasing deciles of total alcool BPH consumption followed the same pattern as found for the categorical results.
We next considered alcohol consumption data provided alcool BPH alumni on both the and questionnaires and the risk of prostate cancer Table 3. As before, adjustment for confounders other than age had little impact on the RR.
Only Such alcool BPH with any increases in alcohol consumption may have at least a twofold increase in prostate cancer risk. Men were more apt to decrease their alcohol consumption; however, only men 4.
Those who reduced their alcohol consumption from to still had a somewhat elevated risk alcool BPH prostate cancer compared to men reporting almost never for alcohol consumption at both timepoints. Finally, we considered whether lifetime alcohol consumption, defined as any amount of alcohol alcool BPH on the college physical exam,and questionnaire, was associated with the risk of prostate cancer. Additional adjustment for the dietary factors modestly attenuated the RR to 1.
We found a positive association between total alcohol consumption and the risk of prostate cancer in a cohort of older, male alumni. When we considered beverage-specific effects, only liquor or spirits, e.
Finally, men who maintained or increased their total alcohol consumption during an year period had an alcool BPH twofold increased risk of prostate cancer alcool BPH to men with no consumption during the same period. The consideration of alcohol consumption during college did not add information beyond the two assessments during adult years. The present study suggests that there may be differential effects for wine, beer, and liquor consumption on the risk of prostate cancer within the moderate range of intake.
On the other hand, there was alcool BPH significant association between wine consumption and risk of prostate cancer. The lack of a linear or non-linear trend for increasing beer alcool BPH suggests that this may be a chance finding. However, the presence of oestrogenic substances, which may be inversely associated with prostate cancer, in beer may explain our results.
The aetiology of prostate cancer remains poorly elucidated, with few alcool BPH behavioural or dietary factors. Alcohol may increase prostate cancer risk by affecting the composition and functioning of cell membranes, causing free radical generation, affecting the metabolism of detoxification enzymes, depressing levels of DNA repair enzymes, or impairing immune function.
Our follow-up period of 5 years may be alcool BPH to precisely alcool BPH any effect of alcohol consumption alcool BPH the risk of prostate cancer. The long latent period for prostate cancer suggests that chronic patterns in diet, behaviour, and other potential preventive measures may be better suited for study.
However, alcool BPH starting follow-up inat alcool BPH time the mean age was We found that increasing alcohol consumption from middle to late adulthood may increase the subsequent risk of prostate cancer. When we examined men reporting any alcohol consumption starting in college, we did not find any appreciable differences in the RR compared with the results limited to the questionnaire.
This finding that alcohol may have deleterious effects on prostate cancer development in middle-aged and older men is consistent with the aetiologically relevant period of prostate alcool BPH.
Some methodological limitations should be also considered. First, the measurement of alcohol consumption may be susceptible to misclassification. If random with respect to the occurrence of prostate cancer, this would bias our results toward the null. Alternatively, alcool BPH among heavier drinkers who underestimated their alcohol intake may underlie the observed increased risk of prostate cancer in moderate drinkers. However, previous validation studies suggest alcool BPH self-reported alcohol consumption is reasonably reliable and valid, 40 — 42 so any misclassification should only modestly affect our risk estimates.
In addition, our measurement of alcohol alcool BPH in the distant past was based on information collected in the past, thereby increasing precision.
Second, the increase in prostate-specifc antigen PSA screening during the follow-up period may explain our results if moderate drinkers tended alcool BPH be screened more frequently, thus increasing their likelihood of a prostate cancer diagnosis. However, this is unlikely, since PSA screening is associated with healthier behaviours. Finally, uncontrolled confounding may explain our results. Higher levels of alcohol consumption in male alumni may be associated with other dietary alcool BPH biochemical markers, which in turn increase the risk alcool BPH prostate cancer.
However, given the lack of knowledge for other relevant potential confounders, it remains unclear whether residual alcool BPH would explain our results. Since most studies found no relation between alcohol and prostate cancer, it is important to consider why we found a positive association. The higher socioeconomic status of Harvard alumni compared to previous studies may have affected PSA screening rates and subsequent prostate cancer diagnoses.
It is also possible that the relevant exposure period for alcohol in the aetiology of prostate carcinogenesis is at older ages; however, previous studies have generally investigated younger men. In conclusion, we found a positive association alcool BPH moderate alcohol consumption and the risk of prostate cancer in a cohort of older men. Liquor consumption, rather than wine or beer consumption, appeared to account for this increased risk.
The consideration of past alcohol consumption as far back as college time did not appreciably alter our results.