Prostate cancer link to vasectomy is weak
Despite a blue-ribbon panel’s 1993 finding that there is insufficient evidence linking prostate cancer to vasectomy, health care providers still get quizzed on the subject when men come for sterilization counseling.
Two large cohort studies published in 1993 found a small increased relative risk for pros-tate cancer in vasectomized men.1,2 The relative risks of 1.56 and 1.66 represent a weak association.3 Three other studies of similar design reported no such association.4,5,6
Several divisions of the National Institutes of Health (NIH) examined the research and issued a joint statement that same year.7 The statement asserts three things:
1. Providers should continue to offer vasectomy and perform the procedure.
2. Reversal of vasectomies is not warranted to prevent prostate cancer.
3. Screening for prostate cancer should not be any different for men who have had a vasectomy than for those who have not.
Face fears up front
Deal with the cancer link proactively as a standard part of counseling, suggests Joel Feigin, MD, associate professor of family medicine at Robert Wood Johnson Medical School in New Brunswick, NJ, and director of the Coventry No-Scalpel Vasectomy Center in Phillipsburg, NJ. Feigin performed about 150 no-scalpel vasectomies last year. He serves as a no-scalpel vasectomy trainer for AVSC International in New York City.
Feigin approaches the subject by talking about the low possibility of complications from vasectomy. He moves from immediate possible complications, such as bleeding, bruising, and infection, then mentions that there are no known long-term complications. "My next statement is that You may have heard about prostate cancer and whether or not there’s a link,’" Feigin says. He then shares the three main points from the NIH 1993 consensus statement.
By far the strongest link to increased risk for prostate cancer is family history, says Thomas R. (Randy) Pritchett, MD, a urologist on the clinical faculty of the University of Washington and the department of urology at Virginia Mason Medical Center in Seattle. The other weak associations are diet, race, and vasectomy.
"There is definitely a link between testosterone and prostate cancer," he says. "What makes me feel comfortable with still doing lots of vasectomies is that doing a vasectomy does not make a man’s testosterone level higher or lower."
Pritchett hasn’t changed his screening practices in light of the vasectomy research, nor has he slowed his pace of performing vasectomies. He performs between 150 to 200 procedures each year, not counting those done while serving as an AVSC no-scalpel vasectomy trainer.
(Editor’s note: The American Urological Associa-tion in Baltimore includes the consensus statement on its World Wide Web site. Go to http:auanet.org/ pub_pat/ and click on "policy statements.")
References
1. Giovannucci E, Ascherio A, Rimm EB, et al. A prospective cohort study of vasectomy and prostate cancer in U.S. men. JAMA 1993; 269:873-877.
2. Giovannucci E, Tosteson TD, Speizer FE, et al. A retrospective cohort study of vasectomy and prostate cancer in U.S. men. JAMA 1993; 269:878-882.
3. Pollack AE. Male and female sterilization: Long-term health consequences. Outlook 1993; 11:2.
4. Massey FJ Jr, Bernstein GS, O’Fallon WM, et al. Vasectomy and health: Results from a large cohort study. JAMA 1984; 252:1,023-1,029.
5. Nienhuis H, Goldacre M, Seagroatt V, et al. Incidence of disease after vasectomy: A record linkage retrospective cohort study. BMJ 1992; 304:743-746.
6. Sidney S, Quesenberry CP Jr., Sadler MC, et al. Vasectomy and the risk of prostate cancer in a cohort of multiphasic health-checkup examinees: Second report. Cancer Causes Control 1991; 2:113-116.
7. Vasectomy and Prostate Cancer Conference. Department of Health and Human Services. The National Institute of Child Health and Human Development, The National Cancer Institute, The National Institute of Diabetes and Digestive and Kidney Diseases. March 2, 1993.
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