{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T18:56:53Z","timestamp":1790535413566,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The association between alcohol consumption and prostate cancer (PCa) outcomes remains mixed, with particularly limited data on the association between alcohol consumption and risk of upgrading among men undergoing active surveillance (AS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed men with Grade Group (GG) 1 PCa managed in a prospectively maintained AS cohort who, at the time of AS enrollment, completed a questionnaire assessing average weekly alcohol consumption during the 5 years preceding PCa diagnosis. Alcohol intake was categorized as &lt;\u20091, 1\u20136, and \u2265\u20097 drinks per week. Multivariable competing risk regression was used to evaluate self\u2010reported alcohol intake for association with any upgrading (to \u2265\u2009GG2) and extreme upgrading (to \u2265\u2009GG3) on surveillance biopsy, adjusting for baseline clinicopathological factors, smoking, self\u2010reported race, and body mass index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1506 men were included. After a median follow\u2010up of 3.5 years (quartiles 1.6\u20136.2) from confirmatory biopsy, 527 men experienced upgrading, including 166 with extreme upgrading. In multivariable regression models adjusted for covariates, higher baseline alcohol consumption was associated with increased risk of upgrading to \u2265\u2009GG2 (\n                      <jats:italic>p\u2010<\/jats:italic>\n                      value for linear trend 0.003). Compared with &lt;\u20091 drink per week, consumption of \u2265\u20097 drinks per week was associated with a 51% higher risk of upgrading to \u2265\u2009GG2 (subdistribution hazard ratio 1.51, 95% confidence interval 1.19\u20131.90). In a sensitivity analysis, each additional drink per week was associated with a 4% higher risk of upgrading (SHR 1.04, 95% CI 1.02\u20131.06). Alcohol consumption was not associated with extreme upgrading.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a large prospective cohort of men undergoing AS, higher baseline self\u2010reported alcohol consumption was associated with upgrading to \u2265\u2009GG2 on surveillance biopsy. No association was observed with extreme upgrading. These findings may inform clinical counseling regarding alcohol use during AS, although further studies are needed to validate our findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pros.70259","type":"journal-article","created":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T18:38:47Z","timestamp":1790534327000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is a Few Too Many? Alcohol Consumption and Prostate Cancer Upgrading During Active Surveillance"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8546-6541","authenticated-orcid":false,"given":"Jack","family":"Campbell","sequence":"first","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3089-5274","authenticated-orcid":false,"given":"Michelle I.","family":"Higgins","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3215-6192","authenticated-orcid":false,"given":"Zhuo Tony","family":"Su","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4597-7064","authenticated-orcid":false,"given":"Yuezhou","family":"Jing","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5161-3769","authenticated-orcid":false,"given":"Mufaddal","family":"Mamawala","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia K.","family":"Landis","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6058-6635","authenticated-orcid":false,"given":"Carlos A.","family":"Rivera Lopez","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirmish","family":"Singla","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8532-0251","authenticated-orcid":false,"given":"Christian P.","family":"Pavlovich","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3529-9295","authenticated-orcid":false,"given":"Bruce J.","family":"Trock","sequence":"additional","affiliation":[{"name":"The James Buchanan Brady Urological Institute Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.4406"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-026-01085-9"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2014.579"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21858"},{"key":"e_1_2_10_6_1","unstructured":"U.S. Department of Agriculture; U.S. Department of Health and Human Services. Guidance on Alcoholic Beverages. In: Dietary Guidelines for Americans 2020\u20132025. 9th ed. U.S. Department of Agriculture and U.S. Department of Health and Human Services; 2020:48\u201049. Accessed October 5 2025 https:\/\/www.dietaryguidelines.gov\/resources\/2020-2025-dietary-guidelines-online-materials."},{"key":"e_1_2_10_7_1","volume-title":"Alcohol and Cancer Risk: The U.S. Surgeon General's Advisory","author":"U.S. Department of Health and Human Services","year":"2025"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.24423"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.27877"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-016-2891-z"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31307"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.02462"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-07-2888"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/bco2.70086"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/CEJ.0b013e32834dbc11"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2019.12.017"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1038\/pcan.2016.22"},{"key":"e_1_2_10_18_1","unstructured":"World Health Organization. \u201cNo Level of Alcohol Consumption is Safe for Our Health.\u201d WHO Regional Office for Europe. Published January 4 2023. Accessed October 5 2025 https:\/\/www.who.int\/europe\/news\/item\/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health."},{"key":"e_1_2_10_19_1","volume-title":"Heavy Drinking Among U.S. Adults, 2018","author":"Boersma P.","year":"2020"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13093173"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canlet.2008.12.011"}],"container-title":["The Prostate"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70259","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pros.70259","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pros.70259","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T18:38:48Z","timestamp":1790534328000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pros.70259"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,27]]},"references-count":20,"alternative-id":["10.1002\/pros.70259"],"URL":"https:\/\/doi.org\/10.1002\/pros.70259","archive":["Portico"],"relation":{},"ISSN":["0270-4137","1097-0045"],"issn-type":[{"value":"0270-4137","type":"print"},{"value":"1097-0045","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,27]]},"assertion":[{"value":"2026-07-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"pros.70259"}}