Is it OK if I drink?

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I’m not sure exactly how one could do a prospective study on the question of drinking and cancer, but I am sure you can find thousands of articles on the topic. As I have written in the past, if you wish to do literature searches that are somewhat better than just Google, use PubMed or Google Scholar. Both of these will take you to peer-reviewed articles on anything, as opposed to “just googling” it. My search today for “drinking + cancer” on PubMed found 16,377 articles. By contrast, a standard Google search for the same two words found 295 million hits. Narrowing the view to drinking and prostate cancer at PubMed gets us to 523 articles, and “drinking alcohol prostate cancer” finds 317.

My impetus for writing this post is two-fold. First, I think that the question itself is one of the most common I am asked in my regular clinic, so it seems to be of some interest to many men. If the woman/wife who accompanies the patient asks, I am usually alerted to this being an ongoing “issue” for the man with prostate cancer. Second, I was reminded to think about the topic by yet another article that appeared in one of the journals I follow. This most recent publication was from the Health Professionals Follow-Up Study that evaluated 47,568 cancer free men from 1986-2012 during which time 5,182 (10.9%) developed prostate cancer. They started off 90% caucasian at an average age of 55, and not exercising much. (~9-12 MET-h/week which is the equivalent of walking for 3-4 hours 3 times a week at 3 miles/hr). The results of the study as stated in the abstract are:

Total alcohol intake among patients with prostate cancer was not associated with progression to lethal prostate cancer (any v none: HR, 0.99 [95% CI, 0.57 to 1.72]), whereas moderate red wine intake was associated with a lower risk (any v none: HR, 0.50 [95% CI, 0.29 to 0.86]; Ptrend = .05). Compared with none, 15 to 30 g/d of total alcohol after prostate cancer diagnosis was associated with a lower risk of death (HR, 0.71 [95% CI, 0.50 to 1.00]), as was red wine (any v none: HR, 0.74 [95% CI, 0.57 to 0.97]; P trend = .007).

A quick look at some of the other articles in the PubMed search seems to support this conclusion. For example a study in Finnish twins found similar protection from light alcohol intake while heavy drinking increased risk. A meta-analysis of 27 studies also reported a slight protective effect of an occasional drink:

Screen Shot 2019-05-17 at 8.40.07 AM

Note that a glass of wine or 12 oz of beer contains 14 g of EtOH. so that the “occasional” drinker in the above graph has a drink every 1-2 weeks.

Feel free to do you own research on the other articles, but my recommendation is that it is OK to have one drink a week (maybe even good for you) and probably red wine would be the best choice. But you should incorporate exercise into the formula and only let yourself have this if you have done 50+ minutes of vigorous exercise at least 3 times during the week. Otherwise, you are kidding yourself about “doing everything you can” to stave off the grim reaper.


Filed under General Prostate Cancer Issues

10 responses to “Is it OK if I drink?

  1. albert stahmer

    Thanks Mike, at 78 years it makes me feel good to know you are not going to make me stop enjoying an occasion glass of red wine. Warm Regards, Heinie


  2. At 78, you can even enjoy a single malt so far as I’m concerned! 🙂

  3. Dr. Jacob Schor

    It’s interesting to note the U-shape of the graph you use to illustrate the relationship. This sort of dose-response is known as a hormetic response in contrast to a straight line response. Such U shapes or inverted U-shapes (depending on how you set up the axis) are common, particularly with natural substances, a category in which alcohol fits. We see similar changing impacts with doses with things like vitamin D, chocolate, and a list of other substances, in particular with prostate cancer. It’s often not what we eat but how much of it we take in that matters more. While you are on PubMed, try a simple search:

  4. Good point and an interesting/common biologic phenomenon as you point out. Of course, we should also note the overlapping standard error bars which tend to indicate the U-shape may not be very significant in the first place. (to say nothing of the fact that the ordinate shows only a 10% change in the whole shebang anyway…until you get to 45-60+ gm/d at which point prostate cancer may not be your main problem!

  5. Damon Fellman MD

    Dear MIchael: Love the blog. Where did the 50+ minutes vigorous exercise 3x per week come from? A tough goal, but I might try and get close if there is a strong reason to do so. I like 3-3.5 mph on the treadmill. Should the focus be on MET-h per week?

  6. Brent Campbell

    Jog (or bike) bar to bar🍷

  7. JJ

    Prostate cancer screening and early detection does NOT saves men’s lives. Let’s do the math. Per the USPSTF (a US government health agency): “A small benefit and known harms from prostate cancer screening” and “Only one man in 1,000 could possibly have a life saving benefit from screening”. However about 1.3 to 3.5 deaths per 1,000 from prostate blind biopsies. Also 5 men in 1000 died and 20.4% had one or more complications within 30 days of a prostatectomy. This does not include deaths and injuries from other procedures, medical mistakes, increased suicide rate, ADT therapy complications, heart attracts, etc, caused by screening and treatments. Detection and overtreatment for prostate cancer has killed or destroyed millions of men’s lives worldwide from understated and multiple undisclosed side effects. The doctor that invented the PSA test, Dr. Richard Ablin now calls it: “The Great Prostate Mistake”, “Hoax” and “A Profit Driven Public Health Disaster”.

    My story:

    Recommended books:
    The Great Prostate Hoax by Richard Ablin MD (the inventor of the PSA test)
    The Big Scare, The Business of Prostate Cancer by Anthony Horan MD.

  8. The controversy about pca screening goes on. The potential downsides should be discussed. I have covered screening in several blog posts easily discovered by looking for “screening” at Newer molecular tests provide hope that we can avoid treating men who don’t need treatment, and FAR more men are now followed with surveillance rather than aggressive treatment – and again molecular tests and MRI’s may make this simpler than doing repetitive biopsies. At present we save a few lives and save some men from spending their last 5 years of life on ADT which is worth considering, but at the cost of toxicities to all men who are treated.

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