Q: “Is there evidence vasectomy causes prostate cancer?”
The answer is “NO”, but the question is more complicated, read on…
There have been some front page articles recently stating vasectomy increases the risk of prostate cancer. This has been based on a recent study by the Journal of Clinical Oncology. It observed, that men with a vasectomy have a higher risk (19 in 1000 rather than 16 in 1000) to develop aggressive prostate cancer and that young men up to their late 30ies were more at risk.
Q: “Is it true that men, who had a vasectomy have a higher risk of prostate cancer?”
A: Yes, we have know this for some time. What this study adds is the fact that it was a much larger population studied. The study looked at a population for 24 years. It observed that this was particularly important in a subgroup of young men.
Q: “Do they have evidence that vasectomy itself is the cause of the increased risk in prostate cancer?”
A: No. This is the shortcoming of this and all other studies. There is a lack of causality. There is at present NO evidence that vasectomy CAUSES prostate cancer. It could partially or fully be down to population bias.
What does this mean?
What studies have observed is that the group of men that had a vasectomy had a slightly higher risk of aggressive prostate cancer. However, since then there have a lot of questions by experts*:
- “The rise is very small – could there be a statistic variability? Is an excess of three cases in a thousand significant? The relative error in random difference for 1000 cases is three, the observed difference in the two groups.”
- “Prostate cancer diagnoses are rare enough that the measurement error probably exceeds the difference they observed. The headline is not justified by the size of the difference and the article is not justified by the sample and limitations of the analysis”. This error was also observed by the American Urology Association, who has dismissed the results.
- “Could it be, that men seeking vasectomy have higher promiscuity levels and therefore higher testosterone levels (or because of higher testosterone levels are more promiscuous / i.e. testosterone is associated with prostate cancer)”
- Are there other factors involved?
*comments taken from experts in a variety of publications
Of course, being a provider of vasectomies I am in some way biased myself and I fully recognise this. However, I also have 12 years of experience with the procedure and if I was concerned to be causing lasting health issues for patients I would not provide it.
Thus I will now try to put my own thinking and the current thinking of others into a summary:
- Other experts have not supported any call to reduce or stop vasectomy as a way of contraception.
- The American Urology Association has dismissed the study as statistically not sound
- There is a view that further research is needed.
- Thinking about this logically, it is difficult to understand how keeping sperm away from the prostate gland should be the cause of an increase of prostate cancer.
- Alternative explanations are just as viable.
- Also, the alternative for many men is condoms, worry and near misses, lack of enjoyment of sex, more babies, female contraception (with all its side effects on their wive health) etc.
Personally, I had a vasectomy. I have a family history of prostate cancer. I am NOT worried, because I believe other factors including diet and smoking are much more important. However, if you are now still worried this may be a good reason NOT to have a vasectomy and there are plenty of good and new female alternatives available (but of course all of them also associated with risks and side effects.)