Originally published 5/30/2016
Does vasectomy increase the risk for prostate cancer (PCa)? The evidence has been mixed, so there’s no clear position on the matter. To refresh the 2016 blog below, here are two newer papers in which the authors combed through many earlier studies—not all of equal research quality—to form their own conclusion:
- Xu et al. (2021) analyzed 58 studies, representing 16,989,237 men. They found a significant association of vasectomy with greater risk of low-grade PCa, intermediate-grade PCa, and advanced PCa—but no significant correlation with PCa-specific mortality. They concluded that doctors should inform patients of these risks before vasectomy.[i]
- On the other hand, Baboudjian et al. (2022) arrived at a more hedge-your-bets finding. Their analysis of 37 studies that included a total of 16,931,805 patients did find a link between vasectomy and any (mainly localized) PCa. However, they qualified that conclusion, noting that “when examining studies of robust design and high quality,” the effects were nearly nonexistent. Thus, they discovered a correlation “without being able to determine whether the procedure leads to a higher prostate cancer incidence.”[ii]
Keep in mind that correlation does NOT indicate causality, no matter how tempting it is to believe that vasectomy causes PCa. There are many other variables that might account for the link. Furthermore, although there are theories about how blocking sperm from ejaculation might affect prostate tissue, no one has yet produced a satisfactory biological explanation for such an effect, and whether it could cause genomic mutations to occur. Finally, earlier studies linking vasectomy with heart disease, autoimmune disorders, dementia, stroke, high blood pressure, and testicular cancer have largely been debunked.
Men considering vasectomy should rest assured that it does not block testosterone and does not alter testosterone blood levels. It also does not affect sexual function—in fact, getting rid of worry over an unplanned pregnancy may lead to better sexual performance and enjoyment. Most experts still consider vasectomy a very safe and effective method of preventing pregnancy.
People are talking about the latest news: there may be a connection between having a vasectomy and being at risk for prostate cancer. A new study from the Harvard School of Public Health has raised a red flag in the minds of men who already had vasectomies, and those who are considering them.
Before getting upset, it’s helpful to understand the background, and how the current study was done. Historically, most studies found no connection between vasectomy and a greater chance of prostate cancer. What makes this study different is the number of cases from which data was drawn, and the number of years involved. The researchers had access to files on 49,405 U.S. men who were followed from 1986-2010 (participants in the Health Professionals Follow-Up Study). Their ages ranged from 40-75 at the start of the 24-year study. Over that period, 6,023 of them were diagnosed with PCa (roughly 1 out of 8), and 811 died specifically because of their cancer.
When the data was analyzed, the overall increased risk of developing nonaggressive PCa was 10% for those who had a vasectomy. This is a relative increase, not an absolute risk, we’re talking about. For example, if you live in Omaha and you have a 5% absolute chance of catching the flu in September, I might have a 10% greater chance than you because I work in highly congested New York City. Ten percent of 5 equals 0.5 ; this means I have a 5.5% chance compared to your 5%. There’s almost no difference. My relatively greater chance would be so small that I would not lose sleep over it.
However, what disturbs men about this study was the higher correlation between vasectomy and aggressive, or dangerous, PCa. To quote one news report, “… further analysis found vasectomy was linked to a stronger increased risk of more aggressive forms of prostate cancer: a 19% higher risk for advanced cancer and a 20% higher risk of the lethal form.” Still, even though this sounds high, we have to go back to the idea of absolute vs. relative risk. It’s not as high as it sounds.
Why might vasectomy create a higher disease risk for prostate cancer? One theory is a protein change in semen, but no one really knows.
The bottom line is, if you’ve had a vasectomy and are worried about your risk for prostate cancer, consider getting a baseline 3T multiparametric MRI (3T mpMRI) of the prostate. This type of imaging is noninvasive (at least, the way we do it does not involve any rectal insertion) and is particularly sensitive to the kind of cancers that are worrisome in this study. In the future, you can use imaging to monitor from time to time, knowing that early detection allows the greatest number of treatment choices.
Whatever you do, don’t lose sleep over the relativeincrease in the odds. They are still very, very small.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Xu Y, Li L, Yang W, Zhang K et al. Association between vasectomy and risk of prostate cancer: a meta-analysis. Prostate Cancer Prostatic Dis. 2021 Dec;24(4):962-975.
[ii] Baboudjian M, Rajwa P, Barret E, Beauval JB et al. Vasectomy and Risk of Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Open Sci. 2022 May 19;41:35-44.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
