EXECUTIVE SUMMARY

A new systematic review and meta-analysis of three decades of evidence concludes that vasectomies are associated with minimal risk of prostate cancer.

  • Researchers involved in the review wanted to evaluate evidence surrounding vasectomy and prostate cancer risk because of the ongoing controversy despite decades of research on the topic.
  • To conduct the analysis, scientists looked at 53 studies: 16 cohort studies involving 2,563,519 men; 33 case-control studies involving 44,536 men; and four cross-sectional studies involving 12,098,221 men. Their review found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. The analysis did determine a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design.

A new systematic review and meta-analysis of three decades of evidence concludes that vasectomies are associated with minimal risk of prostate cancer.1

Researchers involved in the review wanted to evaluate evidence surrounding vasectomy and prostate cancer risk because of the ongoing controversy despite decades of research on the topic, says lead author Bimal Bhindi, MD, CM, MSc, FRCSC, a clinical fellow in urologic oncology in the Rochester, MN-based Mayo Clinic’s Department of Urology.

“Furthermore, several recent high-quality studies with diverging conclusions have been recently reported and have reignited the debate,” notes Bhindi. “We hoped to synthesize the literature through a systematic review in order to potentially settle the debate.”

Researchers looked at 53 studies: 16 cohort studies involving 2,563,519 men; 33 case-control studies involving 44,536 men; and four cross-sectional studies involving 12,098,221 men. Their analysis found no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer. The analysis did determine a weak association between vasectomy and any prostate cancer that was closer to the null with increasingly robust study design.1

While patients should be counseled appropriately about risks, concerns about the risk of prostate cancer should not stop clinicians from offering vasectomy to couples seeking long-term contraception, the researchers state in the paper.1

Why the Debate?

Family planning clinicians recognize vasectomy as a highly effective form of permanent birth control. In the first year after the procedure, just 15 to 20 of every 10,000 couples will experience a pregnancy. Performed as a simple outpatient procedure under local anesthetic, it is less expensive and has a lower risk of complications compared with tubal ligation.2,3 While 43 million women worldwide rely on vasectomy for contraception, the birth control option is underutilized in the United States.4 It is estimated that 8% to 12% of U.S. couples choose vasectomy for contraception.5

Findings from several reports published in the late 1980s and early 1990s suggested an epidemiologic association between vasectomy and the risk of prostate cancer.6,7,8 However, such data were not enough to impede acceptance of the method’s safety and effectiveness, as noted in the 2012 guidance from the American Urological Association:

“Clinicians do not need to routinely discuss prostate cancer, coronary heart disease, stroke, hypertension, dementia or testicular cancer in pre-vasectomy counseling of patients because vasectomy is not a risk factor for these conditions.”9

Several large, high-quality analyses published recently have demonstrated either an association or no association between vasectomy and prostate cancer, which has brought the issue to the forefront again.10,11 Such debate led the current research team to perform its review of the evidence.

Check American Cancer Society Data

A large study published in 2016 by the American Cancer Society added to the evidence that vasectomy does not meaningfully increase the risk for prostate cancer. Researchers looked at data from 1982-2012 collected from the Cancer Prevention Study II (CPS-II), a prospective mortality study of approximately 1.2 million Americans. They analyzed the association between vasectomy and prostate cancer deaths among 363,726 men in the study, and also examined the association between vasectomy and prostate cancer incidence among 66,542 men in a subgroup called the CPS-II Nutrition Cohort.

The data suggest no evidence that vasectomy increases the risk of prostate cancer, the researchers report. Vasectomy also did not increase the risk of high-grade prostate cancer, the kind more likely to be lethal. Findings also suggest that vasectomy did not increase the risk of dying from prostate cancer.12

REFERENCES

  1. Bhindi B, Wallis CJD, Nayan M, et al. The association between vasectomy and prostate cancer: A systematic review and meta-analysis. JAMA Intern Med 2017; doi: 10.1001/jamainternmed.2017.2791.
  2. Sharlip ID, Belker AM, Honig S, et al; American Urological Association. Vasectomy: AUA guideline. J Urol 2012;188(6 Suppl):2482-2491.
  3. Shih G, Turok DK, Parker WJ. Vasectomy: The other (better) form of sterilization. Contraception 2011;83:310-315.
  4. Pile JM, Barone MA. Demographics of vasectomy—USA and international. Urol Clin North Am 2009;36:295-305.
  5. Daniels K, Daugherty J, Jones J, Mosher W. Current contraceptive use and variation by selected characteristics among women aged 15-44: United States, 2011-2013. Natl Health Stat Report 2015;(86):1-14.
  6. Mettlin C, Natarajan N, Huben R. Vasectomy and prostate cancer risk. Am J Epidemiol 1990;132:1056-1061.
  7. Giovannucci E, Ascherio A, Rimm EB, et al. A prospective cohort study of vasectomy and prostate cancer in US men. JAMA 1993;269:873-877.
  8. Giovannucci E, Tosteson TD, Speizer FE, et al. A retrospective cohort study of vasectomy and prostate cancer in US men. JAMA 1993;269:878-882.
  9. American Urological Association. Vasectomy. Available at: http://bit.ly/2uQa1Yg. Accessed Aug. 21, 2017.
  10. Siddiqui MM, Wilson KM, Epstein MM, et al. Vasectomy and risk of aggressive prostate cancer: A 24-year follow-up study. J Clin Oncol 2014;32:3033-3038.
  11. Nayan M, Hamilton RJ, Macdonald EM, et al; Canadian Drug Safety and Effectiveness Research Network (CDSERN). Vasectomy and risk of prostate cancer: Population based matched cohort study. BMJ 2016 355:i5546.
  12. Jacobs EJ, Anderson RL, Stevens VL, et al. Vasectomy and prostate cancer incidence and mortality in a large US cohort. J Clin Oncol 2016;34:3880-3885.