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Baboudjian M, Rajwa P, Barret E, Beauval JB, Brureau L, Créhange G, Dariane C, Fiard G, Fromont G, Gauthé M, Mathieu R, Renard-Penna R, Roubaud G, Ruffion A, Sargos P, Rouprêt M, Ploussard G. Vasectomy and Risk of Prostate Cancer: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 41:35-44. [PMID: 35633829 PMCID: PMC9130083 DOI: 10.1016/j.euros.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Context Previous reports have shown an association between vasectomy and prostate cancer (PCa). However, there exist significant discrepancies between studies and systematic reviews due to a lack of strong causal association and residual confounding factors such as prostate-specific antigen (PSA) screening. Objective To assess the association between vasectomy and PCa, in both unadjusted and PSA screen-adjusted studies. Evidence acquisition We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The PubMed, Scopus, and Web of Science databases were searched in January 2022 for studies that analyzed the association between vasectomy and PCa. Evidence synthesis A total of 37 studies including 16 931 805 patients met our inclusion criteria. A pooled analysis from all studies showed a significant association between vasectomy and any-grade PCa (odds ratio [OR] 1.23; 95% confidence interval [CI], 1.10–1.37; p < 0.001; I2 = 96%), localized PCa (OR 1.08; 95% CI, 1.06–1.11; p < 0.00001; I2 = 31%), or advanced PCa (OR 1.07; 95% CI, 1.02–1.13; p = 0.006; I2 = 0%). The association with PCa remained significant when the analyses were restricted to studies with a low risk of bias (OR 1.06; 95% CI, 1.02–1.10; p = 0.02; I2 = 48%) or cohort studies (OR 1.09; 95% CI, 1.04–1.13; p < 0.0001; I2 = 64%). Among studies adjusted for PSA screening, the association with localized PCa (OR 1.06; 95% CI, 1.03–1.09; p < 0.001; I2 = 0%) remained significant. Conversely, vasectomy was no longer associated with localized high-grade (p = 0.19), advanced (p = 0.22), and lethal (p = 0.42) PCa. Conclusions Our meta-analysis found an association between vasectomy and any, mainly localized, PCa. However, the effect estimates of the association were increasingly close to null when examining studies of robust design and high quality. On exploratory analyses including studies, which adjusted for PSA screening, the association for aggressive and/or advanced PCa diminished. Patient summary In this study, we found an association between vasectomy and the risk of developing localized prostate cancer without being able to determine whether the procedure leads to a higher prostate cancer incidence.
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Association between vasectomy and risk of prostate cancer: a meta-analysis. Prostate Cancer Prostatic Dis 2021; 24:962-975. [PMID: 33927357 DOI: 10.1038/s41391-021-00368-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/12/2021] [Accepted: 04/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The debate over the association between vasectomy and prostate cancer has been lasted about 40 years and there is no sign of stopping. In the present study, we aimed to evaluate whether vasectomy is associated with prostate cancer based on the most comprehensive and up-to-date evidence available. METHODS The PubMed, Cochrane Library, and EMBASE databases were systematically searched inception to March 14, 2021 without year or language restriction. Multivariable adjusted risk ratios (RRs) were used to assess each endpoint. Risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS A total of 58 studies involving 16,989,237 participants fulfilled inclusion criteria. There was significant association of vasectomy with risk of any prostate cancer (risk ratio, 1.18, 95% CI, 1.07-1.31). Association between vasectomy and advanced prostate cancer (risk ratio, 1.06, 95% CI, 1.01-1.12), low-grade prostate cancer (risk ratio, 1.06, 95% CI, 1.02-1.10), and intermediate-grade prostate cancer (risk ratio, 1.12, 95% CI, 1.03-1.22) were significant. There was no significant association between vasectomy and prostate cancer-specific mortality (risk ratio, 1.01, 95% CI, 0.93-1.10). CONCLUSIONS This study found that vasectomy was associated with the risk of any prostate cancer and advanced prostate cancer. From the current evidence, patients should be fully informed of the risk of prostate cancer before vasectomy.
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Yang F, Li J, Dong L, Tan K, Huang X, Zhang P, Liu X, Chang D, Yu X. Review of Vasectomy Complications and Safety Concerns. World J Mens Health 2021; 39:406-418. [PMID: 32777870 PMCID: PMC8255399 DOI: 10.5534/wjmh.200073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/25/2023] Open
Abstract
Vasectomy is a simple, safe, effective, and economical method used worldwide for long-term male contraception. As a surgical operation, it has short-term and long-term complications such as hematoma formation, infection, sterilization failure, sperm granulomas, short-term postoperative pain (nodal pain, scrotal pain, and ejaculation pain), and chronic pain syndrome. Whether it increases the risk of autoimmune disease, cardiovascular disease, testicular cancer, or prostate cancer is still controversial. Changes in plasma concentrations of luteinizing hormone, follicle-stimulating hormone, and testosterone after vasectomy have also been studied, as well as the relation between vasectomy and sexual function. Sperm quality decreases very slowly after vasectomy, and vasovasostomy and intracytoplasmic sperm injection could help a couple achieve a pregnancy if they change their minds at any point. We include a follow-up strategy and suggestions for follow-up care at the end of this review.
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Affiliation(s)
- Fang Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Junjun Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liang Dong
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Kun Tan
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaopeng Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Peihai Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaozhang Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Degui Chang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xujun Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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Cheng S, Yang B, Xu L, Zheng Q, Ding G, Li G. Vasectomy and prostate cancer risk: a meta-analysis of prospective studies. Carcinogenesis 2021; 42:31-37. [PMID: 32772072 DOI: 10.1093/carcin/bgaa086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/07/2020] [Accepted: 08/01/2020] [Indexed: 12/31/2022] Open
Abstract
Epidemiological cohort studies investigating the association between vasectomy and prostate cancer risk have yielded inconsistent results. The aim of the present meta-analysis is to update the evidence on the association between vasectomy and prostate cancer. A comprehensively literature search of relevant studies was performed in December 2019 using PubMed. A DerSimonian and Laird random-effects model was used to calculate the summary relative risk (RR) and its 95% confidence interval (CI). A total of 15 eligible cohort studies (16 data sets) with more than four million of participants were eventually included in this meta-analysis. There was a statistically significant higher risk of prostate cancer among men who underwent vasectomy (RR: 1.09, 95% CI: 1.04-1.13) with obvious heterogeneity among included studies (P < 0.001, I2 = 64.2%). Vasectomy was also associated with the risk of advanced prostate cancer (RR: 1.07, 95% CI: 1.02-1.13), which is less likely to be affected from detection bias. In conclusion, findings from this meta-analysis of prospective studies indicate that vasectomy may be positively associated with the risk of prostate cancer. Further large prospective studies with long follow-up are warranted to verify the findings from this meta-analysis. In addition, the potential underlying molecular mechanism needed further exploration with in vitro and animal studies.
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Affiliation(s)
- Sheng Cheng
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Bo Yang
- Department of Urology, Shanghai Zhou Pu Hospital, Shanghai University of Medicine and Health Sciences, Shanghai, People's Republic of China
| | - Liwei Xu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qiming Zheng
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Kawahara T, Teramoto Y, Li Y, Ishiguro H, Gordetsky J, Yang Z, Miyamoto H. Impact of Vasectomy on the Development and Progression of Prostate Cancer: Preclinical Evidence. Cancers (Basel) 2020; 12:E2295. [PMID: 32824199 PMCID: PMC7464827 DOI: 10.3390/cancers12082295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/07/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
Some observational studies have implied a link between vasectomy and an elevated risk of prostate cancer. We investigated the impact of vasectomy on prostate cancer outgrowth, mainly using preclinical models. Neoplastic changes in the prostate were compared in transgenic TRAMP mice that underwent vasectomy vs. sham surgery performed at 4 weeks of age. One of the molecules identified by DNA microarray (i.e., ZKSCAN3) was then assessed in radical prostatectomy specimens and human prostate cancer lines. At 24 weeks, gross tumor (p = 0.089) and poorly differentiated adenocarcinoma (p = 0.036) occurred more often in vasectomized mice. Vasectomy significantly induced ZKSCAN3 expression in prostate tissues from C57BL/6 mice and prostate cancers from TRAMP mice. Immunohistochemistry showed increased ZKSCAN3 expression in adenocarcinoma vs. prostatic intraepithelial neoplasia (PIN), PIN vs. non-neoplastic prostate, Grade Group ≥3 vs. ≤2 tumors, pT3 vs. pT2 tumors, pN1 vs. pN0 tumors, and prostate cancer from patients with a history of vasectomy. Additionally, strong (2+/3+) ZKSCAN3 expression (p = 0.002), as an independent prognosticator, or vasectomy (p = 0.072) was associated with the risk of tumor recurrence. In prostate cancer lines, ZKSCAN3 silencing resulted in significant decreases in cell proliferation/migration/invasion. These findings suggest that there might be an association between vasectomy and the development and progression of prostate cancer, with up-regulation of ZKSCAN3 expression as a potential underlying mechanism.
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Affiliation(s)
- Takashi Kawahara
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yuki Teramoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Yi Li
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
| | - Hitoshi Ishiguro
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Kanagawa Institute of Industrial Science and Technology, Kawasaki 210-0821, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Jennifer Gordetsky
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
- Departments of Pathology and Urology, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Zhiming Yang
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA; (T.K.); (Y.T.); (Y.L.); (H.I.); (J.G.); (Z.Y.)
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
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Seikkula H, Kaipia A, Hirvonen E, Rantanen M, Pitkäniemi J, Malila N, Boström PJ. Vasectomy and the risk of prostate cancer in a Finnish nationwide population-based cohort. Cancer Epidemiol 2019; 64:101631. [PMID: 31760357 DOI: 10.1016/j.canep.2019.101631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION & OBJECTIVES There are conflicting reports on the association of vasectomy and the risk of prostate cancer (PCa). Our objective was to evaluate the association between vasectomy and PCa from a nationwide cohort in Finland. MATERIALS & METHODS Sterilization registry of Finland and the Finnish Cancer Registry data were utilized to identify all men who underwent vasectomy between years 1987-2014 in Finland. Standard incidence ratio (SIR) for PCa as well as all-cause standardized mortality ratios (SMR) were calculated. RESULTS We identified 38,124 men with vasectomy with a total of 429,937 person-years follow-up data. The median age at vasectomy was 39.7 years (interquartile range [IQR] 35.9-44.0), after vasectomy PCa was diagnosed in 413 men (122 cases 0-10 years, 219 cases 10-20 years and 72 cases >20 years from vasectomy). SIR for PCa for the vasectomy cohort was 1.15 (95% CI: 1.04-1.27). By the end of follow-up, 19 men had died from PCa, while the expected number was 20.5 (SMR 0.93 [95%CI: 0.56-1.44]). The overall mortality was decreased (SMR 0.54 [95%CI: 0.51-0.58]) among men with vasectomy. CONCLUSION We found a small statistically significant increase in PCa incidence after vasectomy, but in contrast the mortality of vasectomized men was significantly reduced. This may be due to higher likelihood of vasectomized men to undergo prostate-specific antigen testing, having healthier general lifestyle and other biological factors e.g. high reproductive fitness.
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Affiliation(s)
- Heikki Seikkula
- Department of Surgery, Central Hospital of Central Finland, Jyväskylä, Finland Keskussairaalantie 19, 40620, Jyväskylä, Finland.
| | - Antti Kaipia
- Department of Urology, Tampere University Hospital, Tampere, Finland PL 2000, 33521 Tampere, Finland.
| | - Elli Hirvonen
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland.
| | - Matti Rantanen
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland.
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland.
| | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland Unioninkatu 22, 00130, Helsinki, Finland; School of Health Sciences, University of Tampere, Finland.
| | - Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland, Department of Urology, University of Turku, Turku, Finland Kiinamyllynkatu 4-8, 20100, Turku, Finland.
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