Baboudjian Michael, Rajwa Pawel, Barret Eric, Beauval Jean-Baptiste, Brureau Laurent, Créhange Gilles, Dariane Charles, Fiard Gaëlle, Fromont Gaëlle, Gauthé Mathieu, Mathieu Romain, Renard-Penna Raphaële, Roubaud Guilhem, Ruffion Alain, Sargos Paul, Rouprêt Morgan, Ploussard Guillaume
Department of Urology, APHM, North Academic Hospital, Marseille, France.
Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Eur Urol Open Sci. 2022 May 19;41:35-44. doi: 10.1016/j.euros.2022.04.012. eCollection 2022 Jul.
Previous reports have shown an association between vasectomy and prostate cancer (PCa). However, there exist significant discrepancies between studies and systematic reviews due to a lack of strong causal association and residual confounding factors such as prostate-specific antigen (PSA) screening.
To assess the association between vasectomy and PCa, in both unadjusted and PSA screen-adjusted studies.
We performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The PubMed, Scopus, and Web of Science databases were searched in January 2022 for studies that analyzed the association between vasectomy and PCa.
A total of 37 studies including 16 931 805 patients met our inclusion criteria. A pooled analysis from all studies showed a significant association between vasectomy and any-grade PCa (odds ratio [OR] 1.23; 95% confidence interval [CI], 1.10-1.37; < 0.001; I = 96%), localized PCa (OR 1.08; 95% CI, 1.06-1.11; < 0.00001; I = 31%), or advanced PCa (OR 1.07; 95% CI, 1.02-1.13; = 0.006; I = 0%). The association with PCa remained significant when the analyses were restricted to studies with a low risk of bias (OR 1.06; 95% CI, 1.02-1.10; = 0.02; I = 48%) or cohort studies (OR 1.09; 95% CI, 1.04-1.13; < 0.0001; I = 64%). Among studies adjusted for PSA screening, the association with localized PCa (OR 1.06; 95% CI, 1.03-1.09; < 0.001; I = 0%) remained significant. Conversely, vasectomy was no longer associated with localized high-grade ( = 0.19), advanced ( = 0.22), and lethal ( = 0.42) PCa.
Our meta-analysis found an association between vasectomy and any, mainly localized, PCa. However, the effect estimates of the association were increasingly close to null when examining studies of robust design and high quality. On exploratory analyses including studies, which adjusted for PSA screening, the association for aggressive and/or advanced PCa diminished.
In this study, we found an association between vasectomy and the risk of developing localized prostate cancer without being able to determine whether the procedure leads to a higher prostate cancer incidence.
既往报告显示输精管切除术与前列腺癌（PCa）之间存在关联。然而，由于缺乏强有力的因果关联以及残余混杂因素（如前列腺特异性抗原（PSA）筛查），各研究和系统评价之间存在显著差异。
评估在未调整及PSA筛查调整研究中输精管切除术与PCa之间的关联。
我们根据系统评价与Meta分析的首选报告项目进行了一项系统评价。2022年1月在PubMed、Scopus和Web of Science数据库中检索分析输精管切除术与PCa之间关联的研究。
共有37项研究（包括16931805例患者）符合我们的纳入标准。所有研究的汇总分析显示，输精管切除术与任何分级的PCa（比值比[OR]1.23；95%置信区间[CI]，1.10 - 1.37；P < 0.001；I² = 96%）、局限性PCa（OR 1.08；95% CI，1.06 - 1.11；P < 0.00001；I² = 31%）或晚期PCa（OR 1.07；95% CI，1.02 - 1.13；P = 0.006；I² = 0%）之间存在显著关联。当分析仅限于偏倚风险较低的研究（OR 1.06；95% CI，1.02 - 1.10；P = 0.02；I² = 48%）或队列研究（OR 1.09；95% CI，1.04 - 1.13；P < 0.0001；I² = 64%）时，与PCa的关联仍然显著。在针对PSA筛查进行调整的研究中，与局限性PCa的关联（OR 1.06；95% CI，1.03 - 1.09；P < 0.001；I² = 0%）仍然显著。相反，输精管切除术与局限性高级别（P = 0.19）、晚期（P = 0.22）和致命性（P = 0.42）PCa不再相关。
我们的Meta分析发现输精管切除术与任何类型（主要是局限性）的PCa之间存在关联。然而，在检查设计稳健和高质量的研究时，该关联的效应估计值越来越接近零。在包括针对PSA筛查进行调整的研究的探索性分析中，侵袭性和/或晚期PCa的关联减弱。
在本研究中，我们发现输精管切除术与发生局限性前列腺癌的风险之间存在关联，但无法确定该手术是否会导致前列腺癌发病率升高。
