Abstract
Background: Vasectomy has been implicated as a risk factor for prostate cancer in multiple epidemiologic studies over the past 25 years. Whether this relationship is causal remains unclear. This study examines the association between vasectomy and prostate cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, which randomized men to usual care or annual prostate cancer screening.Methods: We performed a retrospective analysis of 13-year screening and outcomes data from the PLCO trial. Multivariable Cox proportional hazards regression stratified by study arm and age at vasectomy was performed.Results: There was an increased risk of prostate cancer in men who had undergone a vasectomy and were randomized to the usual care arm of the study (adjusted HR, 1.11; 95% confidence interval, 1.03-1.20; P = 0.008). There was no association between vasectomy and diagnosis of prostate cancer in men randomized to the prostate cancer screening arm. Only men undergoing vasectomy at an older age in the usual care arm of the study, but not the prostate cancer screening arm, were at increased risk of being diagnosed with prostate cancer.Conclusions: Vasectomy was not associated with prostate cancer risk among men who were screened for prostate cancer as part of a clinical trial, but was associated with prostate cancer detection in men receiving usual care.Impact: The positive association between vasectomy and prostate cancer is likely related to increased detection of prostate cancer based on patterns of care rather than a biological effect of vasectomy on prostate cancer development. Cancer Epidemiol Biomarkers Prev; 26(11); 1653-9. ©2017 AACR.
Highlights
Vasectomy is the safest and most cost effective form of permanent sterilization [1, 2]
Impact: The positive association between vasectomy and prostate cancer is likely related to increased detection of prostate cancer based on patterns of care rather than a biological effect of vasectomy on prostate cancer development
While we previously reported on the very high rate of PSA screening in both arms of the trial, we hypothesized that men in the screening arm would have undergone standardized detection protocols, while men in the control arm would have had more variable detection based on vasectomy status [32]
Summary
Vasectomy is the safest and most cost effective form of permanent sterilization [1, 2]. Concerns about an increased risk of prostate cancer associated with vasectomy initially arose from case–control studies in the late 1980s and early 1990s [6,7,8]. This association was reinforced by two large cohort studies that found an approximately 1.6-fold increase in the relative risk of prostate cancer in men who had undergone a vasectomy [9, 10]. Vasectomy has been implicated as a risk factor for prostate cancer in multiple epidemiologic studies over the past 25 years. This study examines the association between vasectomy and prostate cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, which randomized men to usual care or annual prostate cancer screening
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