Fowke Jay H, Howard Lauren, Andriole Gerald L, Freedland Stephen J
Division of Epidemiology, Departments of Medicine and Department of Surgical Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Urology Section, Veterans Affairs Medical Center, Durham, NC, USA.
Eur Urol. 2014 Dec;66(6):1133-8. doi: 10.1016/j.eururo.2014.01.037. Epub 2014 Feb 9.
Although most studies found no association between alcohol intake and prostate cancer (PCa) risk, an analysis of the Prostate Cancer Prevention Trial found that high alcohol intake significantly increased PCa risk among men randomized to the 5α-reductase inhibitor (5-ARI) finasteride.
Determine whether alcohol affects PCa risk among men taking the 5-ARI dutasteride.
DESIGN, SETTINGS, AND PARTICIPANTS: Reduction by Dutasteride of Prostate Cancer Events was a 4-yr, multicenter, randomized, double-blind, placebo-controlled trial to compare PCa after dutasteride administration (0.5mg/d) with placebo. Participants had a baseline prostate-specific antigen between 2.5 and 10.0 ng/ml and a recent negative prostate biopsy. Alcohol intake was determined by baseline questionnaire, and participants underwent a prostate biopsy to determine PCa status at 2 yr and 4 yr of follow-up.
Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between alcohol intake and low-grade (Gleason <7) and high-grade (Gleason >7) PCa.
Of 6374 participants in our analysis, approximately 25% reported no alcohol consumption, 49% were moderate drinkers (one to seven drinks per week), and 26% were heavy drinkers (more than seven drinks per week). Alcohol intake was not associated with low- or high-grade PCa in the placebo arm and was not associated with low-grade PCa among men taking dutasteride. In contrast, men randomized to dutasteride and reporting more than seven drinks per week were 86% more likely to be diagnosed with high-grade PCa (p=0.01). Among alcohol abstainers, dutasteride was associated with significantly reduced risk of high-grade PCa (OR: 0.59; 95% CI, 0.38-0.90), but dutasteride was no longer associated with reduced high-grade PCa among men reporting high alcohol intake (OR: 0.99; 95% CI, 0.67-1.45).
Alcohol consumption negated a protective association between dutasteride and high-grade PCa.
We confirmed a prior study that alcohol affects PCa prevention in patients taking 5-ARIs. Patients taking 5-ARIs may wish to eliminate alcohol intake if they are concerned about PCa.
尽管大多数研究未发现饮酒与前列腺癌（PCa）风险之间存在关联，但一项对前列腺癌预防试验的分析发现，高酒精摄入量显著增加了随机接受5α-还原酶抑制剂（5-ARI）非那雄胺治疗的男性患PCa的风险。
确定酒精是否会影响服用5-ARI度他雄胺的男性患PCa的风险。
设计、设置和参与者：度他雄胺降低前列腺癌事件发生率研究是一项为期4年的多中心、随机、双盲、安慰剂对照试验，旨在比较服用度他雄胺（0.5mg/天）与安慰剂后的PCa情况。参与者的基线前列腺特异性抗原在2.5至10.0 ng/ml之间，且近期前列腺活检结果为阴性。通过基线问卷确定酒精摄入量，并在随访的第2年和第4年对参与者进行前列腺活检以确定PCa状态。
采用多变量逻辑回归计算酒精摄入量与低级别（Gleason<7）和高级别（Gleason>7）PCa之间关联的优势比（OR）和95%置信区间（CI）。
在我们分析的6374名参与者中，约25%报告不饮酒，49%为中度饮酒者（每周饮用1至7杯），26%为重度饮酒者（每周饮用超过7杯）。在安慰剂组中，酒精摄入量与低级别或高级别PCa无关，在服用度他雄胺的男性中，酒精摄入量与低级别PCa也无关。相比之下，随机接受度他雄胺治疗且报告每周饮酒超过7杯的男性被诊断为高级别PCa的可能性高86%（p=0.01）。在戒酒者中，度他雄胺与高级别PCa风险显著降低相关（OR：0.59；95%CI，0.38-0.90），但在报告高酒精摄入量的男性中，度他雄胺与高级别PCa风险降低不再相关（OR：0.99；95%CI，0.67-1.45）。
饮酒消除了度他雄胺与高级别PCa之间的保护关联。
我们证实了之前的一项研究，即酒精会影响服用5-ARI的患者的PCa预防。如果担心患PCa，服用5-ARI的患者可能希望戒酒。
