Vasectomy and Prostate Cancer: More Questions Than Answers

Abstract

As many as 500,000 US men are believed to have had a vasectomy in 1991, and at least four million US couples of reproductive age depend upon the method. About 42 million couples worldwide also rely upon vasectomy for contraception. Concern arose in the family planning community in February 1993 when two studies published in the Journal of the American Medical Association reported that vasectomized men are at higher risk of developing prostate cancer compared to nonvasectomized men. Prostate cancer is the second most common cause of cancer death among American men. Vasectomy, however, is among the safest, most effective, and most acceptable of contraceptive methods. A link between vasectomy and prostate cancer could therefore have a serious negative impact upon vasectomy practice and upon overall contraceptive practice in the US. The National Institutes of Health convened a panel of experts in March 1993 to assess the likelihood of a relationship between vasectomy and prostate cancer and to make recommendations about any changes in vasectomy practice which may be needed. The panel concluded that there was insufficient basis for recommending a change in clinical and public health practice at that time, but that the debate must be resolved. To that end, epidemiologic and basic biological research are needed. The author reviews the background of the debate, early questions, and recent developments, and discusses future research.