Department of Urology, Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
Andrology. 2019 Mar;7(2):178-183. doi: 10.1111/andr.12570. Epub 2019 Feb 3.
Several studies have linked vasectomy with the risk of prostate cancer; however, this association has been attributed to selection bias. Since vasectomy is a common and effective form of contraception, these implications are significant. Therefore, we sought to test this association in a large observational cohort.
To evaluate the potential association between prior vasectomy and the risk of developing prostate cancer.
We evaluated the relationship between vasectomy and prostate cancer in the NIH-AARP Diet and Health Study. Of the 111,914 men, prostate cancer was identified in 13,885 men and vasectomies were performed in 48,657. We used multivariate analysis to examine the relationship between prostate cancer and vasectomy. We also performed propensity score-adjusted and propensity score-matched analysis.
Men utilizing vasectomy were more likely to be ever married, fathers, educated, white, and screened for prostate cancer. During 4,251,863 person-years of follow-up, there was a small association between vasectomy and incident prostate cancer with a hazard ratio of 1.05 (95% CI, 1.01-1.11). However, no significant association was found when looking separately at prostate cancer by grade or stage. Conclusions were similar when using propensity adjustment and matching. Importantly, a significant interaction between vasectomy and PSA screening was identified.
Estimates of the association between vasectomy and prostate cancer are sensitive to analytic method underscoring the tenuous nature of the connection. Given the differences between men who do and do not utilize vasectomy, selection bias appears likely to explain any identified association between vasectomy and prostate cancer.
With over 20 years of follow-up, no convincing relationship between vasectomy and prostate cancer of any grade was identified.
多项研究表明输精管切除术与前列腺癌风险相关，但这种关联归因于选择偏倚。由于输精管切除术是一种常见且有效的避孕方法，因此这些影响意义重大。因此，我们试图在一个大型观察队列中检验这种关联。
评估既往输精管切除术与前列腺癌发病风险之间的潜在关联。
我们评估了 NIH-AARP 饮食与健康研究中输精管切除术与前列腺癌之间的关系。在 111914 名男性中，有 13885 名男性被诊断为前列腺癌，有 48657 名男性接受了输精管切除术。我们使用多变量分析来检查前列腺癌与输精管切除术之间的关系。我们还进行了倾向评分调整和倾向评分匹配分析。
接受输精管切除术的男性更有可能已婚、有子女、受过教育、为白人且接受过前列腺癌筛查。在 4251863 人年的随访期间，输精管切除术与前列腺癌发病之间存在微弱关联，风险比为 1.05（95%CI，1.01-1.11）。然而，当分别观察前列腺癌的分级或分期时，未发现显著关联。倾向调整和匹配后的结论相似。重要的是，确定了输精管切除术和 PSA 筛查之间存在显著的交互作用。
输精管切除术与前列腺癌之间关联的估计值对分析方法敏感，突出了这种联系的脆弱性。鉴于接受和不接受输精管切除术的男性之间存在差异，选择偏倚似乎很可能解释了输精管切除术与前列腺癌之间已确定的任何关联。
在超过 20 年的随访中，未发现输精管切除术与任何分级的前列腺癌之间存在令人信服的关系。
