By: Eric A. Klein, MD
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Vasectomy is one of the simplest and most effective long-term birth control methods. Yet only 8 to 12 percent of U.S. couples choose it.
One reason may be old fears about vasectomy increasing the risk of prostate cancer. A 2017 study should finally end that debate.
“This is a very strong analysis that should lay those fears to rest, once and for all,” says Glickman Urologic & Kidney Institute Chairman Eric A. Klein, MD. “This study, involving 3 million patients, is the largest ever conducted. It found no meaningful increased risk of prostate cancer for men who have had a vasectomy.”
About vasectomy and tubal ligation
Vasectomy and tubal ligation are both long-term forms of birth control:
- Vasectomy involves tying off the vas deferens to prevent a man from releasing sperm during ejaculation. This simple outpatient procedure involves local anesthesia and produces minimal discomfort.
- Tubal ligation involves tying off the fallopian tubes to prevent a woman’s eggs from being fertilized. This more complex operation requires general anesthesia and has a higher risk of complications.
Early findings disputed
The past three decades have seen many studies looking at the risk of prostate cancer among men who have had a vasectomy.
But inconsistent results have fueled an ongoing debate. Some studies found no relationship between vasectomy and prostate cancer. Several from the late 1980s and 1990s reported a slight correlation.
“While the risk in those studies was only slightly elevated, it made some men who were interested in vasectomy rethink their choice,” says Dr. Klein.
However, most of the studies were limited in size and scope, involving either small groups of patients, similar patient populations or single institutions.
In contrast, the new meta-analysis reviews 53 studies of varying design and involving large groups of patients.
“When you ask a question over such a broad segment of the population, you’re going to get much closer to the truth than you would in any individual study,” notes Dr. Klein. “And that is what this study did.”
Correlation vs. causation
But the main criticism of the early studies was that “correlation is not causation,” says Dr. Klein. In other words, just because prostate cancer was found more often among men who had had vasectomies doesn’t mean the vasectomy caused the cancer.
“No one ever came up with a strong or plausible biologic explanation for why these two things should be linked,” he says.
Critics of the early reports also pointed out the “cascade effect.” Men with vasectomies had already seen a urologist. So they were more likely to return later for PSA (prostate-specific antigen) testing. And PSA testing would make a biopsy and a prostate cancer diagnosis more likely.
“The fact that this study found no increased risk of prostate cancer from prior vasectomy should set everyone’s mind at ease,” Dr. Klein concludes.