by David Y. Josephson, MD, FACS
A vasectomy is a safe and highly effective method for contraception. There are nearly 500,000 men who undergo vasectomies annually in the United States. This procedure can be performed safely with minimal morbidity in an office setting with just a local anesthetic or under light sedation for select patients who want a bit more anesthesia.
Throughout the past 30 plus years, many studies have attempted to shed light on the controversial topic by asking, “is there a link between vasectomies and prostate cancer?” Thus far, most studies found contradicting results and were inconclusive.
A recent prospective cohort study by a group from Harvard reported an increased risk for higher grade and lethal diseases. Their study included a 24 year longitudinal study on 49,000 patients, 25% of which had undergone a vasectomy in their late 30’s. Of the total population in the study, 6,000 men were diagnosed with prostate cancer around the age of 70. 12% of patients with a history of a vasectomy were diagnosed with prostate cancer while 1.5% of those patients were diagnosed with high-grade prostate cancer. The authors of this study after analyzing data, drew a conclusion that patients with history of vasectomy had a 10% higher relative risk of prostate cancer compared to those without the procedure.
It is important to recognize that patients who undergo a vasectomy will most likely elect closer medical follow ups with their doctors than those that do not. In the above mentioned study, when authors analyzed those patients with regular check ups for prostate cancer, they found high prevalence of prostate cancer without any difference between groups with vasectomy versus not.
In other words, during this particular study and as recent as 2012, Prostatic Specific Antigen (PSA) testing was used more prevalently and therefore led to more diagnosis/definitive treatment of prostate cancer. Therefore, we can assume that many patients with and without vasectomy who received closer follow ups, underwent PSA testing and biopsies more often which increased the likelihood of diagnosing such common cancer among men.
At this time, there is no hard evidence that links a vasectomy with subsequent risk of getting prostate cancer. Prostate cancer is understood as a multifactorial disease. However, as a urologic surgeon specializing in cancers, I am obliged to discuss all possible risks associated with a vasectomy including hypothetical possibilities for occurrence of higher prostate cancer. In my opinion and experience however, there is no definitive link or risk. I anticipate seeing a future appropriately designed study confirming my beliefs.