Prostate cancer (PC) survivors may potentially use substances to cope with psychological distress or poorly-controlled physical symptoms. However, little is known about long-term risks of alcohol use disorder (AUD) or drug use disorders (DUD) in men with PC.
A national cohort study was conducted in Sweden of 180,189 men diagnosed with PC during 1998-2017 and 1,801,890 age-matched population-based control men. AUD and DUD were ascertained from nationwide records through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors and prior psychiatric disorders. Subanalyses examined differences by PC treatment during 2005-2017.
Men with high-risk PC had increased risks of both AUD (adjusted HR, 1.44; 95% CI, 1.33-1.57) and DUD (1.93; 1.67-2.24). Their AUD risk was highest in the first year and was no longer significantly elevated ≥5 years after PC diagnosis, whereas their DUD risk remained elevated ≥10 years after PC diagnosis (adjusted HR, 2.26; 95% CI, 1.45-3.52), particularly opioid use disorder (3.07; 1.61-5.84). Those treated only with androgen deprivation therapy (ADT) had the highest risks of AUD (adjusted HR, 1.91; 95% CI, 1.62-2.25) and DUD (2.23; 1.70-2.92). Low- or intermediate-risk PC was associated with modestly increased risks of AUD (adjusted HR, 1.38; 95% CI, 1.30-1.46) and DUD (1.19; 1.06-1.34).
In this large cohort, men with PC had significantly increased risks of both AUD and DUD, especially those with high-risk PC and treated only with ADT. PC survivors need long-term psychosocial support and timely detection and treatment of AUD and DUD.
JNCI cancer spectrum. 2023 Jun 30 [Epub ahead of print]
Casey Crump, Pär Stattin, James D Brooks, Jan Sundquist, Alexis C Edwards, Weiva Sieh, Kristina Sundquist
Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA., Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Department of Urology, Stanford University School of Medicine, Stanford, CA, USA., Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA., Department of Epidemiology, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.