| Resum: |
We found a significant association between vasectomy and any-grade, localized, and advanced prostate cancer. However, the effect estimates were increasingly close to null when examining studies of robust design and high quality. Future well-designed studies with attention to potential residual confounders, which were not taken into account in large cohort studies, are needed. 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; p < 0. 001; I 2 = 96%), localized PCa (OR 1. 08; 95% CI, 1. 06-1. 11; p < 0. 00001; I 2 = 31%), or advanced PCa (OR 1. 07; 95% CI, 1. 02-1. 13; p = 0. 006; I 2 = 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; p = 0. 02; I 2 = 48%) or cohort studies (OR 1. 09; 95% CI, 1. 04-1. 13; p < 0. 0001; I 2 = 64%). Among studies adjusted for PSA screening, the association with localized PCa (OR 1. 06; 95% CI, 1. 03-1. 09; p < 0. 001; I 2 = 0%) remained significant. Conversely, vasectomy was no longer associated with localized high-grade (p = 0. 19), advanced (p = 0. 22), and lethal (p = 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. |
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(Fundació Puigvert)
