Drug use disorder and risk of incident and fatal prostate cancer among Swedish men: a nationwide epidemiological study

Abstract

Purpose Prostate cancer is the second most common cancer in men and a leading cause of cancer mortality worldwide. Men with drug use disorders (DUD) may potentially be at high risk for prostate cancer mortality because of delayed diagnosis and/or undertreatment. In this study, we aimed to investigate prostate cancer incidence, mortality, and stage at time of diagnosis among men with DUD compared to the general male population in Sweden. Methods We performed a follow-up study based on Swedish national register data for the period January 1997–December 2016. The study was based on 1,361,532 men aged 50–75 years at inclusion, of whom 9,259 were registered with DUD. Cox regression analysis was used to compute adjusted hazard ratios (HRs) for incident and fatal prostate cancer, and cancer stage at time of diagnosis, associated with DUD. Results DUD was associated with a slightly increased risk of incident prostate cancer (HR: 1.07, 95% confidence interval [CI] 1.00–1.14, p = 0.048) and substantially higher risk of fatal prostate cancer (HR: 1.59, 95% CI 1.40–1.82, p < 0.001), adjusted for age, socioeconomic factors, and comorbidities related to tobacco smoking and alcohol use disorder. No association was found between DUD and prostate cancer stage at diagnosis. Conclusions Men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population. Our findings should raise attention among medical staff and decision-makers towards a disadvantaged group of men in need of easily accessible prostate cancer evaluation and treatment.

Association between Alcohol Intake and Prostate Cancer Mortality and Survival

“…A total of 1994 articles were removed based on their title and abstract, which left 187 papers to be read in full text. Of these, an additional 169 were removed for not matching inclusion criteria, while there were 19 independent studies that were eligible and were included in the review for reporting on the association between consumption of alcoholic beverages and the risk of fatal PCa (n = 5) [ 22 , 29 , 30 , 31 , 32 ], PCa mortality (n = 5) [ 12 , 33 , 34 , 35 , 36 ], and PCa patients’ survival (n = 7) [ 13 , 37 , 38 , 39 , 40 , 41 , 42 ] or surrogates thereof (n = 2) [ 43 , 44 ].…”

“…Of the included studies, the majority are prospective studies (46.7%) and the most frequent study design is the cohort-study (80%). Among the 19 studies included, 11 were carried out in North America [ 13 , 20 , 29 , 30 , 34 , 37 , 38 , 39 , 41 , 42 , 43 ], 4 in Europe [ 31 , 32 , 36 , 44 ], 2 in Asia [ 33 , 35 ], 1 in Australia [ 12 ] and 1 included data from 25 studies within the international PRACTICAL Consortium (USA, Australia and European countries) [ 40 ]. Two studies were large-scale prospective study involving more than 1,300,000 men conducted in Korea [ 33 ] and in Sweden [ 32 ].…”

“…Among the 19 studies included, 11 were carried out in North America [ 13 , 20 , 29 , 30 , 34 , 37 , 38 , 39 , 41 , 42 , 43 ], 4 in Europe [ 31 , 32 , 36 , 44 ], 2 in Asia [ 33 , 35 ], 1 in Australia [ 12 ] and 1 included data from 25 studies within the international PRACTICAL Consortium (USA, Australia and European countries) [ 40 ]. Two studies were large-scale prospective study involving more than 1,300,000 men conducted in Korea [ 33 ] and in Sweden [ 32 ]. The statistical analysis most commonly used in the included studies is the Cox proportional hazards regression model for survival data.…”

“…The meta-analysis including four papers, revealed no association between alcohol consumption (highest vs. lowest) and fatal PCa incidence risk in healthy subjects (SRE 1.01, 95% CI 0.64–1.60, Figure 2 ) [ 22 , 29 , 30 , 31 ]. Dahlman 2022 was not included because the risk estimate is for alcohol abuse/alcoholism [ 32 ].…”

Cancer Association in Drug Abuse Disorders: A latest Update

“…It has been shown that cannabis use is associated with higher incidence of prostate cancer [11], and that substance use disorder (SUD; alcohol included) is associated with adverse health outcomes in men with advanced stage prostate cancer [12,13]. Swedish study showed that men with DUD have an increased risk of fatal prostate cancer, possibly related to undertreatment in this patient population [14].…”