One of the most common questions men diagnosed with prostate cancer ask is: ‘Why me?’
As a prostate surgeon for more than 40 years, I’d usually explain that it was largely down to factors beyond their control: their genes, family history, age and ethnicity. Unlike with many other cancers, lifestyle factors weren’t thought to play such an important role.
Or, at least, that’s what we used to think.
Because in recent years, research has begun to transform our understanding of the disease – suggesting there may be more that men can do to reduce their risk than we previously realised.
And one emerging risk factor has come as a surprise to many of us in the field – myself included: alcohol.
The link between drinking and prostate cancer has long been debated, with previous research producing conflicting results. But a major new study by Finnish researchers provides some of the strongest evidence yet that even modest consumption may matter.
Published in the European Journal of Cancer, the study analysed the drinking habits of more than 82,000 men from six population studies spanning more than four decades. Strikingly, the increased risk was apparent even among relatively light drinkers.
Men consuming just one to four alcoholic drinks a week had an 18 per cent higher incidence of prostate cancer than non-drinkers, those consuming five to 13 drinks had a 20 per cent higher incidence, while those drinking 14 or more a week had a 32 per cent higher incidence.
I want to be clear: this research does not prove alcohol causes prostate cancer, and many of the most important factors that determine a man’s risk remain beyond his control. But after more than 40 years treating men with this disease, I believe the evidence is becoming too significant to ignore.
Jeremy Clarkson, who recently revealed he had been treated for prostate cancer, has said that while he has made changes to his lifestyle, he has no intention of giving up alcohol
And this matters because alcohol is woven into British life. A pint after work, a few drinks with friends or a bottle of wine on the weekend are habits that many of us would barely think twice about.
Doctors are no different. Throughout my career, alcohol has been a normal part of the culture of medicine – from drinks after work to conferences and dinners.
At the same time I’ve watched colleagues and friends in my profession develop and, tragically, die from prostate cancer.
Of course, I cannot say that alcohol was responsible for any of those cases. But findings like these inevitably make you wonder whether we have been overlooking a potentially important piece of the puzzle. So what should men do with this information?
I’m not suggesting that every man needs to give up alcohol completely. The evidence simply isn’t strong enough to justify that advice. But I do think men should know that alcohol may be part of the picture – particularly because, unlike your age, genes or family history, how much you drink is something you can change.
That may not be a message every man wants to hear.
Jeremy Clarkson, who recently revealed he had been treated for prostate cancer, has said that while he has made changes to his lifestyle, he has no intention of giving up alcohol.
I can understand that. And Clarkson has undoubtedly done a great service by speaking so openly about his diagnosis.
In the week after he revealed it, more than 50,000 men used Prostate Cancer UK’s online Risk Checker – six times the number in the previous week – and he has since joined calls for wider access to prostate cancer testing (see panel, above right).
Top Gear star sparked a surge in prostate tests
Jeremy Clarkson and David Cameron sparked a huge surge in checks for prostate cancer, simply by going public with their diagnoses.
Visits to Prostate Cancer UK’s online risk-checker rose 11-fold after both men spoke publicly about having the disease.
While 2,000 men a day used it prior to ex-Prime Minister Lord Cameron, 59, revealing his diagnosis in 2025, more than 22,000 clicked on it the day that followed.
A similar boost was seen after ex-Top Gear star Mr Clarkson, 66, announced his diagnosis on his Amazon show Clarkson’s Farm in June, with visits up from 8,425 a week to 51,000. It’s an uplift that has saved lives, said the charity, but Mr Clarkson insisted: ‘There is plenty more to do. I’ll keep saying it: check your risk. It only takes a couple of minutes and it could save your life.’
Mr Clarkson and Lord Cameron are among survivors demanding wider prostate cancer screening, which this newspaper is campaigning for.
Mr Clarkson has since revealed he is now in remission, while Lord Cameron also said he is cancer-free.
Amy Rylance, from Prostate Cancer UK, said: ‘So many men say a celebrity diagnosis inspired them to check their risk and in some cases saved their life.’
But his comments about alcohol perhaps illustrate just how little-known its possible link with prostate cancer remains.
That is why I think men should at least be aware of this emerging evidence and make their own decisions about how much they drink.
Current UK guidelines advise men and women not to regularly drink more than 14 units of alcohol a week – roughly six pints of average-strength beer or six medium glasses of wine. For men regularly drinking above this level, cutting back is a sensible place to start.
What makes the Finnish findings particularly striking, however, is that the increased incidence of prostate cancer was seen even among relatively light drinkers. And in that study one ‘drink’ corresponded to one and a half units.
That doesn’t mean we should suddenly conclude there is no safe amount of alcohol when it comes to prostate cancer. This is one observational study and, as I’ve said, it cannot prove cause and effect. But there are plausible reasons why alcohol could have an effect.
When the body breaks down alcohol it produces acetaldehyde, a toxic chemical that can damage DNA and interfere with the mechanisms that cells use to repair it.
Researchers have also suggested alcohol may increase oxidative stress – a process that can damage cells – and affect androgen signalling, the system involving male hormones such as testosterone that plays an important role in the development and progression of prostate cancer.
For me, however, the significance of this emerging evidence goes beyond whether men should have one fewer pint.
Prostate cancer is the most common cancer in men, with about 67,000 new cases diagnosed in the UK every year and 12,000 deaths.
Yet earlier this year, the UK National Screening Committee decided against population-wide screening, concluding that the potential harms outweigh the benefits. Instead, screening will be targeted at a relatively small group of men with a high-risk BRCA2 gene mutation.
That leaves millions of men needing to understand their own risk – including factors they may be able to change – and to know when to have a conversation with a doctor about a PSA blood test, which can help detect prostate cancer before symptoms appear.
For most men the biggest risk factors remain those they can do nothing about – particularly their age, genetics and ethnicity.
It is also important to understand what the figures from the Finnish study actually mean. A 32 per cent increase in incidence does not mean a heavy drinker has a 32 per cent chance of developing prostate cancer. It means his existing risk – determined by factors including his age and family history – was about a third higher than if he were a non-drinker.
Alcohol may also matter indirectly because of its relationship with another potentially important risk factor: excess weight.
The relationship between obesity and prostate cancer is complex. Research suggests obese men are less likely to be diagnosed with low-risk prostate cancers, but more likely to develop aggressive or fatal forms of the disease.
One University of Oxford study found that, among overweight men, every additional four inches around the waist was associated with a 7 per cent increase in the risk of dying from prostate cancer. There are several possible explanations for this. Fat cells produce an enzyme called aromatase, which converts testosterone into oestrogen, potentially altering the hormonal environment in which prostate cells grow. Obesity also promotes chronic inflammation throughout the body, which can encourage cancer growth.
And excess weight may even make prostate cancer more difficult to detect. PSA blood tests can be less reliable in men with obesity, potentially allowing tumours to go unnoticed until they are more advanced.
All of this is why I believe men need to have a better understanding of their individual risk and what they can do about it.
For me, that conversation should include PSA testing.
A PSA test measures the level of prostate-specific antigen, a protein produced by the prostate, in the blood. A raised result does not necessarily mean cancer – other, benign prostate conditions can also cause PSA levels to rise – but it can be an important warning sign that further investigation is needed.
If a man’s PSA is raised, the usual next step may include another blood test and an MRI scan of the prostate, followed by a biopsy if something suspicious is identified.
I believe every man from the age of about 40 should know his PSA level and be able to discuss regular testing with his doctor – particularly as he gets older, as the risk linked to age mounts.
This is especially important for men already at higher risk of the disease, such as black men and those with a family history of prostate cancer. And I believe those conversations should increasingly include lifestyle, too.
Of course, there is now considerable uncertainty over how men without symptoms are supposed to access PSA testing.
Until recently, longstanding NHS guidance stated that men aged 50 and over could ask their GP for the test, even if they had no symptoms, after discussing the potential benefits and harms.
That guidance, introduced in 2002, has now been withdrawn. The Government insists this does not mean men have lost an automatic right to a test – because, it says, no such right ever existed and the final decision has always rested with the GP.
But for men trying to take a proactive approach to their prostate health, the situation is undeniably less clear.
New guidance is now being developed to help GPs decide how to deal with men without symptoms who ask for a PSA test but do not qualify for the new targeted screening programme.
For me, that makes awareness more important, not less.
Men need to understand their own risk and feel able to have an informed conversation with their GP about whether a PSA test is appropriate for them.
For decades, alcohol has barely featured in that conversation when it comes to prostate cancer. I think that now needs to change.
So my advice to men is simple: know your risk, talk to your doctor about your PSA, keep your weight under control and stay active.
And if you regularly drink alcohol, consider cutting back.
We may eventually discover that alcohol plays a smaller role in prostate cancer than these latest findings suggest.
But if more than 40 years treating this disease has taught me anything, it is that we should not wait until every last question has been answered before giving men information that could help them protect their health.
Professor Roger Kirby is a urologist and founder of The Prostate Centre
We’re a nation of drinkers – but I might cut back a bit
For most men, a diagnosis of incurable prostate cancer at the age of 52 would come as a shock. But this devastating news was arguably even more surprising for Ian Colby.
The disease has long been linked to unhealthy lifestyle choices such as poor diet and obesity. But Ian, pictured right, a former oil worker from Oxford, not only ate sensibly but was in such good physical shape due to his love of long-distance cycling he was classed as an elite athlete.
However, Ian, now 58, did have one vice: a few beers with his mates.
‘In my youth I was definitely a bit of a lad and had lots of pints,’ he says.
‘And then when I lived abroad I played rugby and we would always celebrate with beers.
Ian, now 58, did have one vice: a few beers with his mates. ‘In my youth I was definitely a bit of a lad and had lots of pints,’ he says
‘I don’t think I drank any more than most British men my age – but then we are a nation of drinkers.’
Until now, he had never considered that alcohol consumption could be linked to prostate cancer.
Nor does he believe that his drinking was the trigger for his disease, which is currently stable.
However, he says the latest research has made him reconsider his drinking habits.
‘I still have a beer or two,’ he says, ‘but I might think about cutting down even more now.’
