Coffee, Caffeine Metabolism Genotype and Disease Progression in Patients with Localized Prostate Cancer Managed with Active Surveillance

J Urol. 2019 Feb;201(2):308-314. doi: 10.1016/j.juro.2018.08.048.


Purpose: Active surveillance is increasingly used as a management strategy for localized prostate cancer. Coffee intake has been associated with a lower prostate cancer incidence. We assessed whether coffee was associated with disease progression in men on active surveillance.

Materials and methods: A total of 411 patients with newly diagnosed Gleason score 6 or 7 prostate cancer were enrolled on a prospective active surveillance protocol for at least 6 months and completed a baseline dietary assessment. The active surveillance protocol included a biennial monitoring regimen with disease progression defined as an increase in the Gleason score. Cox proportional hazards models were used to evaluate associations of coffee intake with progression-free survival. We also evaluated patient genotype in the caffeine metabolism related single nucleotide polymorphism rs762551.

Results: Median followup was 36 months (range 6 to 126) and the Gleason score progressed in 76 of the 411 patients (18.5%). Compared to 0 cups per day, in the multivariable model adjusting for prostate specific antigen, patient age and tumor length, less than 1 cup (HR 0.85, 95% CI 0.40-1.71), 1 to 1.9 cups (HR 0.64, 95% CI 0.29-1.43), 2 to 3.9 cups (HR 0.71, 95% CI 0.35-1.47) and 4 cups or more (HR 1.67, 95% CI 0.81-3.45) were not significantly associated with progression-free survival (p for nonlinearity = 0.01). Patients with low/moderate coffee intake and the AA fast caffeine metabolizer genotype were less likely to experience grade progression than nonconsumers (HR 0.36, 95% CI 0.15-0.88, p = 0.03).

Conclusions: Low to moderate coffee intake appears safe in men on active surveillance of localized prostate cancer. Further work is needed to determine whether high consumption is associated with shorter progression-free survival in sensitive groups.

MeSH terms

  • Aged
  • Caffeine / adverse effects
  • Caffeine / metabolism*
  • Coffee / adverse effects*
  • Cytochrome P-450 CYP1A2 / genetics*
  • Cytochrome P-450 CYP1A2 / metabolism
  • Disease Progression
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Polymorphism, Single Nucleotide
  • Progression-Free Survival
  • Prospective Studies
  • Prostate / pathology
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / genetics
  • Prostatic Neoplasms / mortality*
  • Prostatic Neoplasms / pathology
  • Risk Factors
  • Surveys and Questionnaires / statistics & numerical data
  • Watchful Waiting*


  • Coffee
  • Caffeine
  • CYP1A2 protein, human
  • Cytochrome P-450 CYP1A2