Abstract
BackgroundAn association between male fertility and risk of prostate cancer has been suggested, possibly through lower androgen levels in subfertile men. We evaluated male fertility in relation to risk of prostate cancer by assessing the frequency of fathering of dizygotic twins, a marker of high fertility, among cases of prostate cancer and controls.MethodsWe performed a case-control study in Prostate Cancer data Base Sweden (PCBaSe), a nationwide, population-based cohort. PCBaSe was linked to the Swedish twin register for information on zygosity for same-sex twins and to other nationwide health care registers and demographic databases for information on socioeconomic factors, comorbidity, and tumor characteristics for 96 301 prostate cancer cases and 378 583 matched controls. To account for the influence of in vitro fertilization on dizygotic twinning, analyses were restricted to men who had fathered children before 1991, when in vitro fertilization was still uncommon in Sweden.Results1 112 cases and 4 538 controls had fathered dizygotic twins. Men with dizygotic twins had no increased risk of prostate cancer compared to fathers of singletons; neither for total prostate cancer odds ratio (OR) 0.95(95% CI 0.89–1.02), nor for any risk category, OR 0.97 (95% CI 0.84–1.12) for low-risk disease, and OR 1.04 (95% CI 0.90–1.22) for metastatic disease.ConclusionThe lack of association between fathering of dizygotic twins and prostate cancer risk give no support for an association between male fertility and prostate cancer risk.
Highlights
Fathers have consistently been shown to have a higher risk of prostate cancer than childless men in large population-based observational studies [1,2,3]
Association between dizygotic twin fatherhood status and risk of prostate cancer In univariable analysis, there was no association between fathering of dizygotic twins and risk of prostate cancer overall compared to fathers of singletons; odds ratio (OR) 0.95 for total prostate cancer, or to risk of prostate cancer in different risk categories; for low-risk prostate cancer, OR 0.97 and metastatic prostate cancer, OR 1.05 (Figure 1a)
Men with a high educational level had an increased risk of total prostate cancer compared to men with a low educational level, OR 1.17 (Figure 1b)
Summary
Fathers have consistently been shown to have a higher risk of prostate cancer than childless men in large population-based observational studies [1,2,3]. One possible explanation for this increased risk is through higher androgen levels in the fathers as compared to infertile men, [4,5] as androgen levels might affect risk of prostate cancer [6,7,8]. There are others factors, in addition to male fertility, that affect if a man fathers children, such as fertility of the partner, presence of female partner and wish to have children. Another marker of increased fertility, fathering of dizygotic twins, should not be affected by such factors. An association between male fertility and risk of prostate cancer has been suggested, possibly through lower androgen levels in subfertile men. We evaluated male fertility in relation to risk of prostate cancer by assessing the frequency of fathering of dizygotic twins, a marker of high fertility, among cases of prostate cancer and controls
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