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Vasectomy and risk of prostate cancer: population based matched cohort study

Nayan M, Hamilton RJ, Macdonald EM, Li Q, Mamdani MM, Earle CC, Kulkarni GS, Jarvi KA, Juurlink DN. BMJ. 2016; 355:i5546.

Objective — To determine the association between vasectomy and prostate cancer, adjusting for measures of health seeking behaviour.

Design — Population based matched cohort study.

Setting — Multiple validated healthcare databases in Ontario, Canada, 1994-2012.

Participants — 326 607 men aged 20 to 65 who had undergone vasectomy were identified through physician billing codes and matched 1:1 on age (within two years), year of cohort entry, comorbidity score, and geographical region to men who did not undergo a vasectomy.

Main Outcomes Measures — The primary outcome was incident prostate cancer. Secondary outcomes were prostate cancer related grade, stage, and mortality.

Results — 3462 incident cases of prostate cancer were identified after a median follow-up of 10.9 years: 1843 (53.2%) in the vasectomy group and 1619 (46.8%) in the non-vasectomy group. In unadjusted analysis, vasectomy was associated with a slightly increased risk of incident prostate cancer (hazard ratio 1.13, 95% confidence interval 1.05 to 1.20). After adjustment for measures of health seeking behaviour, however, no association remained (adjusted hazard ratio 1.02, 95% confidence interval 0.95 to 1.09). Moreover, no association was found between vasectomy and high grade prostate cancer (adjusted odds ratio 1.05, 95% confidence interval 0.67 to 1.66), advanced stage prostate cancer (adjusted odds ratio 1.04, 0.81 to 1.34), or mortality (adjusted hazard ratio 1.06, 0.60 to 1.85).

Conclusion — The findings do not support an independent association between vasectomy and prostate cancer.

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Keywords: Prostate cancer Risk assessment