Friday, November 7 World Vasectomy Day

One question often posed by patients before undergoing vasectomy is whether there are any long term risks. Literature from twenty years ago raised the possibility of a link between vasectomy and prostate cancer; however, several reports following the initial report refuted the link and prevailing wisdom holds there are no cancer risks. This was recently reaffirmed by the American Urological Association or AUA.

On November 7th, The AUA released a statement to its physician members “that vasectomy is not a risk factor for prostate cancer or for high grade prostate cancer” and that, as per previous AUA guidelines, “there is no need for physicians to routinely discuss prostate cancer in their preoperative counseling of vasectomy patients.”

In September, 2014, an article reporting a modest association between vasectomy and lethal prostate cancer was published in the Journal of Clinical Oncology (JCO). As a result, several media outlets released articles linking vasectomies to an “increased risk of lethal prostate cancer” and caused anxiety among many of the millions of men who already underwent vasectomies and those who are considering the procedure.

The AUA had previously perfmormed a careful review of vasectomy literature from 1949 to 2011 (including the 1992 and 1993 papers by Giovannucci and co-author Stampfer [who are co-authors of the 2014 JCO article] et. al.), and in 2012 the AUA Vasectomy Guideline Committee concluded that there is no association between vasectomy and prostate cancer or other significant health risks.

Recently, the AUA reviewed the new report as well as additional literature published since 2012. Additionally, a new meta-analysis was completed inclusive of both the previously reported literature from 2012 AUA vasectomy guidelines as well as the new publication.

The review of the recent JCO article identified several problems with its conclusions:

1. There were problems with the article’s methodology with respect to its ability to properly evaluate the risks of lethal prostate cancer;
2. There were inconsistencies with previous reports on the same cohort of men; and
3. There was a risk of bias due to potential residual confounding factors.

These issues raised doubts about the validity of the results reported in the JCO article. Additionally, new AUA meta-analysis produced results very similar to the results of the original meta-analysis reviewed in its 2012 guideline.

Based on the newly examined literature and updated meta-analysis, the AUA has reaffirmed that vasectomy is not a risk factor for prostate cancer or for high grade prostate cancer and it is not necessary for physicians to routinely discuss prostate cancer in their preoperative counseling of vasectomy patients.