Vasectomy and Risk of Prostate Cancer: A Systematic Review and Meta-analysis

Michael Baboudjian; Pawel Rajwa; Eric Barret; Jean-Baptiste Beauval; Laurent Brureau; Gilles Créhange; Charles Dariane; Gaëlle Fiard; Gaëlle Fromont; Mathieu Gauthé; Romain Mathieu; Raphaële Renard-Penna; Guilhem Roubaud; Alain Ruffion; Paul Sargos; Morgan Rouprêt; Guillaume Ploussard; Prostate Cancer Committee of the Association Française d'Urologie CC-AFU

doi:10.1016/j.euros.2022.04.012

Vasectomy and Risk of Prostate Cancer: A Systematic Review and Meta-analysis

Eur Urol Open Sci. 2022 May 19:41:35-44. doi: 10.1016/j.euros.2022.04.012. eCollection 2022 Jul.

Authors

Michael Baboudjian^{1

2

3

4}, Pawel Rajwa^{5

6}, Eric Barret⁷, Jean-Baptiste Beauval^{3

4}, Laurent Brureau⁸, Gilles Créhange⁹, Charles Dariane¹⁰, Gaëlle Fiard¹¹, Gaëlle Fromont¹², Mathieu Gauthé¹³, Romain Mathieu¹⁴, Raphaële Renard-Penna¹⁵, Guilhem Roubaud¹⁶, Alain Ruffion^{17

18}, Paul Sargos¹⁹, Morgan Rouprêt²⁰, Guillaume Ploussard^{3

4

21}; Prostate Cancer Committee of the Association Française d'Urologie CC-AFU

Affiliations

¹ Department of Urology, APHM, North Academic Hospital, Marseille, France.
² Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
³ Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France.
⁴ IUCT-O, Toulouse, France.
⁵ Department of Urology, Medical University of Vienna, Vienna, Austria.
⁶ Department of Urology, Medical University of Silesia, Zabrze, Poland.
⁷ Department of Urology, Institut Mutualiste Montsouris, Paris, France.
⁸ Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Pointe-à-Pitre, France.
⁹ Department of Radiotherapy, Institut Curie, Paris, France.
¹⁰ Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris - Paris University - U1151 Inserm-INEM, Necker, Paris, France.
¹¹ Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
¹² Department of Pathology, CHRU Tours, Tours, France.
¹³ Department of Nuclear Medicine, Scintep - Institut Daniel Hollard, Grenoble, France.
¹⁴ Department of Urology, CHU Rennes, Rennes, France.
¹⁵ AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France.
¹⁶ Department of Medical Oncology, Institut Bergonié, Bordeaux, France.
¹⁷ Service d'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
¹⁸ Equipe 2, Centre d'Innovation en cancérologie de Lyon (EA 3738 CICLY), Faculté de médecine Lyon Sud, Université Lyon 1, Lyon, France.
¹⁹ Department of Radiotherapy, Institut Bergonié, Bordeaux, France.
²⁰ GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France.
²¹ Department of Urology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.

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.

Keywords: Advanced; Localized; Meta-analysis; Prostate cancer; Vasectomy.

Publication types

Review