The debate over the association between vasectomy and prostate cancer has been lasted about 40 years and there is no sign of stopping. In the present study, we aimed to evaluate whether vasectomy is associated with prostate cancer based on the most comprehensive and up-to-date evidence available.
The PubMed, Cochrane Library, and EMBASE databases were systematically searched inception to March 14, 2021 without year or language restriction. Multivariable adjusted risk ratios (RRs) were used to assess each endpoint. Risk of bias was assessed using the Newcastle-Ottawa scale.
A total of 58 studies involving 16,989,237 participants fulfilled inclusion criteria. There was significant association of vasectomy with risk of any prostate cancer (risk ratio, 1.18, 95% CI, 1.07–1.31). Association between vasectomy and advanced prostate cancer (risk ratio, 1.06, 95% CI, 1.01–1.12), low-grade prostate cancer (risk ratio, 1.06, 95% CI, 1.02–1.10), and intermediate-grade prostate cancer (risk ratio, 1.12, 95% CI, 1.03–1.22) were significant. There was no significant association between vasectomy and prostate cancer-specific mortality (risk ratio, 1.01, 95% CI, 0.93–1.10).
This study found that vasectomy was associated with the risk of any prostate cancer and advanced prostate cancer. From the current evidence, patients should be fully informed of the risk of prostate cancer before vasectomy.
Subscribe to Journal
Get full journal access for 1 year
only $99.75 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Shih G, Turok DK, Parker WJ. Vasectomy: the other (better) form of sterilization. Contraception. 2011;83:310–5.
Pile JM, Barone MA. Demographics of vasectomy–USA and international. Urol Clin North Am. 2009;36:295–305.
Miyahira AK, Simons JW, Soule HR. The 20th Annual Prostate Cancer Foundation Scientific Retreat report. Prostate. 2014;74:811–9.
Ross RK, Paganini-Hill A, Henderson BE. The etiology of prostate cancer: what does the epidemiology suggest? Prostate. 1983;4:333–44.
Honda GD, Bernstein L, Ross RK, Greenland S, Gerkins V, Henderson BE. Vasectomy, cigarette smoking, and age at first sexual intercourse as risk factors for prostate cancer in middle-aged men. Br J Cancer. 1988;57:326–31.
Mettlin C, Natarajan N, Huben R. Vasectomy and prostate cancer risk. Am J Epidemiol. 1990;132:1056–61.
Giovannucci E, Tosteson TD, Speizer FE, Ascherio A, Vessey MP, Colditz GA. A retrospective cohort study of vasectomy and prostate cancer in US men. JAMA. 1993;269:878–82.
Hiatt RA, Armstrong MA, Klatsky AL, Sidney S. Alcohol consumption, smoking, and other risk factors and prostate cancer in a large health plan cohort in California (United States). Cancer Causes Control. 1994;5:66–72.
John EM, Whittemore AS, Wu AH, Kolonel LN, Hislop TG, Howe GR, et al. Vasectomy and prostate cancer: results from a multiethnic case-control study. J Natl Cancer Inst. 1995;87:662–9.
Andersson SO, Baron J, Bergström R, Lindgren C, Wolk A, Adami HO. Lifestyle factors and prostate cancer risk: a case-control study in Sweden. Cancer Epidemiol Biomark Prev. 1996;5:509–13.
Platz EA, Yeole BB, Cho E, Jussawalla DJ, Giovannucci E, Ascherio A. Vasectomy and prostate cancer: a case-control study in India. Int J Epidemiol. 1997;26:933–8.
Lesko SM, Louik C, Vezina R, Rosenberg L, Shapiro S. Vasectomy and prostate cancer. J Urol. 1999;161:1848–52.
Emard JF, Drouin G, Thouez JP, Ghadirian P. Vasectomy and prostate cancer in Québec, Canada. Health Place. 2001;7:131–9.
Cox B, Sneyd MJ, Paul C, Delahunt B, Skegg DCG. Vasectomy and risk of prostate cancer. JAMA. 2002;287:3110–5.
Garzotto M, Hudson RG, Peters L, Hsieh Y-C, Barrera E, Mori M, et al. Predictive modeling for the presence of prostate carcinoma using clinical, laboratory, and ultrasound parameters in patients with prostate specific antigen levels < or = 10 ng/mL. Cancer. 2003;98:1417–22.
Lightfoot N, Conlon M, Kreiger N, Sass-Kortsak A, Purdham J, Darlington G. Medical history, sexual, and maturational factors and prostate cancer risk. Ann Epidemiol. 2004;14:655–62.
Sunny L. Is it reporting bias doubled the risk of prostate cancer in vasectomised men in Mumbai, India? Asian Pac J Cancer Prev. 2005;6:320–5.
Liang C-H, Liu Q, Zhou F-J, Gao X, Chen L-W. Etiologic correlations of prostate cancer in Guangdong, China to family history of cancers, and sexual and marital factors-a case-control study. Ai Zheng. 2007;26:484–8.
Holt SK, Salinas CA, Stanford JL. Vasectomy and the risk of prostate cancer. J Urol. 2008;180:2565–7.
Schwingl PJ, Meirik O, Kapp N, Farley TMM. Prostate cancer and vasectomy: a hospital-based case-control study in China, Nepal and the Republic of Korea. Contraception. 2009;79:363–8.
Weinmann S, Shapiro JA, Rybicki BA, Enger SM, Van Den Eeden SK, Richert-Boe KE, et al. Medical history, body size, and cigarette smoking in relation to fatal prostate cancer. Cancer Causes Control. 2010;21:117–25.
van Leeuwen PJ, van den Bergh RCN, Wolters T, Zhu X, Bul M, Schröder FH, et al. Critical assessment of prebiopsy parameters for predicting prostate cancer metastasis and mortality. Can J Urol. 2011;18:6018–24.
Kobayashi LC, Limburg H, Miao Q, Woolcott C, Bedard LL, Massey TE, et al. Folate intake, alcohol consumption, and the methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism: influence on prostate cancer risk and interactions. Front Oncol. 2012;2:100.
Hennis AJM, Wu S-Y, Nemesure B, Leske MC. Urologic characteristics and sexual behaviors associated with prostate cancer in an african-Caribbean population in barbados, west indies. Prostate Cancer. 2013;2013:682750.
Siddiqui MM, Wilson KM, Epstein MM, Rider JR, Martin NE, Stampfer MJ, et al. Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. J Clin Oncol. 2014;32:3033–8.
Eisenberg ML, Li S, Brooks JD, Cullen MR, Baker LC. Increased risk of cancer in infertile men: analysis of U.S. claims data. J Urol. 2015;193:1596–601.
Nayan M, Hamilton RJ, Macdonald EM, Li Q, Mamdani MM, Earle CC, et al. Vasectomy and risk of prostate cancer: population based matched cohort study. BMJ. 2016;355:i5546.
Smith K, Byrne, Castaño JM, Chirlaque MD, Lilja H, Agudo A, et al. Vasectomy and Prostate Cancer Risk in the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Clin Oncol. 2017;35:1297–303.
Davenport MT, Zhang CA, Leppert JT, Brooks JD, Eisenberg ML. Vasectomy and the risk of prostate cancer in a prospective US Cohort: Data from the NIH-AARP Diet and Health Study. Andrology. 2019;7:178–83.
Seikkula H, Kaipia A, Hirvonen E, Rantanen M, Pitkäniemi J, Malila N, et al. Vasectomy and the risk of prostate cancer in a Finnish nationwide population-based cohort. Cancer Epidemiol. 2020;64:101631.
Sheth AR, Panse GT. Can vasectomy reduce the incidence of prostatic tumor? Med Hypotheses. 1982;8:237–41.
Husby A, Wohlfahrt J, Melbye M. Vasectomy and Prostate Cancer Risk: a 38-Year Nationwide Cohort Study. J Natl Cancer Inst. 2020;112:71–77.
Rohrmann S, Paltoo DN, Platz EA, Hoffman SC, Comstock GW, Helzlsouer KJ. Association of vasectomy and prostate cancer among men in a Maryland cohort. Cancer Causes Control. 2005;16:1189–94.
Goldacre MJ, Wotton CJ, Seagroatt V, Yeates D. Cancer and cardiovascular disease after vasectomy: an epidemiological database study. Fertil Steril. 2005;84:1438–43.
Lynge E. Prostate cancer is not increased in men with vasectomy in denmark. J Urol. 2002;168:488–90.
Dennis LK, Dawson DV, Resnick MI. Vasectomy and the risk of prostate cancer: a meta-analysis examining vasectomy status, age at vasectomy, and time since vasectomy. Prostate Cancer Prostatic Dis. 2002;5:193–203.
Shang Y, Han G, Li J, Zhao J, Cui D, Liu C, et al. Vasectomy and prostate cancer risk: a meta-analysis of cohort studies. Sci Rep. 2015;5:9920.
Liu LH, Kang R, He J, Zhao SK, Li FT, Wan SP, et al. Vasectomy and risk of prostate cancer: a systematic review and meta-analysis of cohort studies. Andrology. 2015;3:643–9.
Zhang X-L, Yan J-J, Pan S-H, Pan J-G, Ying X-R, Zhang G-F. Vasectomy and the risk of prostate cancer: a meta-analysis of cohort studies. Int J Clin Exp Med. 2015;8:17977–85.
Bhindi B, Wallis CJD, Nayan M, Farrell AM, Trost LW, Hamilton RJ, et al. The Association Between Vasectomy and Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177:1273–86.
Cheng S, Yang B, Xu L, Zheng Q, Ding G, Li G. Vasectomy and prostate cancer risk: a meta-analysis of prospective studies. Carcinogenesis. 2021;42:31–37.
Shoag J, Savenkov O, Christos PJ, Mittal S, Halpern JA, Askin G, et al. Vasectomy and Risk of Prostate Cancer in a Screening Trial. Cancer Epidemiol Biomark Prev. 2017;26:1653–9.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.
Jacobs EJ, Anderson RL, Stevens VL, Newton CC, Gansler T, Gapstur SM. Vasectomy and Prostate Cancer Incidence and Mortality in a Large US Cohort. J Clin Oncol. 2016;34:3880–5.
Tangen CM, Goodman PJ, Till C, Schenk JM, Lucia MS, Thompson IM. Biases in Recommendations for and Acceptance of Prostate Biopsy Significantly Affect Assessment of Prostate Cancer Risk Factors: results From Two Large Randomized Clinical Trials. J Clin Oncol. 2016;34:4338–44.
Romero FR, Romero AW, Almeida RMSD, Oliveira FCD, Tambara Filho R. The significance of biological, environmental, and social risk factors for prostate cancer in a cohort study in Brazil. Int Braz J Urol. 2012;38:769–78.
Schuman LM, Coulson AH, Mandel JS, Massey FJ, O’Fallon WM. Health Status of American Men–a study of post-vasectomy sequelae. J Clin Epidemiol. 1993;46:697–958.
Nair-Shalliker V, Yap S, Nunez C, Egger S, Rodger J, Patel MI, et al. Adult body size, sexual history and adolescent sexual development, may predict risk of developing prostate cancer: Results from the New South Wales Lifestyle and Evaluation of Risk Study (CLEAR). Int J Cancer. 2017;140:565–74.
Cossack M, Ghaffary C, Watson P, Snyder C, Lynch H. Aspirin use is associated with lower prostate cancer risk in male carriers of BRCA mutations. J Genet Couns. 2014;23:187–91.
Jia Y, Sun XQ, Gao JG, Zhu LY, Weng BW, Liu ZJ. et al. Risk factors of prostate cancer in urban Qingdao: a case-control study. Zhonghua nan ke xue = Natl J Androl. 2013;19:694–8.
Mazdak H, Mazdak M, Jamali L, Keshteli AH. Determination of prostate cancer risk factors in Isfahan, Iran: a case-control study. Med Arh. 2012;66:45–48.
Ganesh B, Saoba SL, Sarade MN, Pinjari SV. Risk factors for prostate cancer: an hospital-based case-control study from Mumbai, India. Indian J Urol. 2011;27:345–50.
Sridhar GMS, Adera T, Ramakrishnan V, Roberts JD. Association between family history of cancers and risk of prostate cancer. J Mens Health. 2010;7:45–54.
Tyagi B, Manoharan N, Raina V. A case control study on prostate cancer in Delhi. Asian Pac J Cancer Prev. 2010;11:397–401.
Pourmand G, Salem S, Mehrsai A, Lotfi M, Amirzargar MA, Mazdak H, et al. The risk factors of prostate cancer: a multicentric case-control study in Iran. Asian Pac J Cancer Prev. 2007;8:422–8.
Patel DA, Bock CH, Schwartz K, Wenzlaff AS, Demers RY, Severson RK. Sexually transmitted diseases and other urogenital conditions as risk factors for prostate cancer: a case–control study in Wayne County, Michigan. Cancer Causes Control. 2005;16:263–73.
Jian L, Xie LP, Lee AH, Binns CW. Protective effect of green tea against prostate cancer: a case-control study in southeast China. Int J Cancer. 2004;108:130–5.
Stanford JL, Wicklund KG, McKnight B, Daling JR, Brawer MK. Vasectomy and risk of prostate cancer. Cancer Epidemiol Biomark Prev. 1999;8:881–6.
Zhu K, Stanford JL, Daling JR, McKnight B, Stergachis A, Brawer MK, et al. Vasectomy and prostate cancer: a case-control study in a health maintenance organization. Am J Epidemiol. 1996;144:717–22.
Ewings P, Bowie C. A case-control study of cancer of the prostate in Somerset and east Devon. Br J Cancer. 1996;74:661–6.
Rosenberg L, Palmer JR, Zauber AG, Warshauer ME, Strom BL, Harlap S, et al. The relation of vasectomy to the risk of cancer. Am J Epidemiol. 1994;140:431–8.
Hsing AW, Wang RT, Gu FL, Lee M, Wang T, Leng TJ, et al. Vasectomy and prostate cancer risk in China. Cancer Epidemiol Biomark Prev. 1994;3:285–8.
Wei Q, Tang X, Yang Y, Zhan Y, Yin H. Risk factors of prostate cancer–a matched case-control study. Hua Xi Yi Ke Da Xue Xue Bao. 1994;25:87–90.
Hayes RB, Pottern LM, Greenberg R, Schoenberg J, Swanson GM, Liff J, et al. Vasectomy and prostate cancer in US blacks and whites. Am J Epidemiol. 1993;137:263–9.
Newell GR, Fueger JJ, Spitz MR, Babaian RJ. A case-control study of prostate cancer. Am J Epidemiol. 1989;130:395–8.
Spitz MRFJ, Babaian RJ, Newell GR, Rosenberg L. Re: “Vasectomy and the risk of prostate cancer”. Am J Epidemiol. 1991;134:107–9.
Alqahtani KS, Srinivasan S, Mital DP, Haque S. Analysis of risk factors for prostate cancer patients. 2015;7:365–80.
Chacko JA, Zafar MB, McCallum SW, Terris MK. Vasectomy and prostate cancer characteristics of patients referred for prostate biopsy. J Urol. 2002;168:1408–11.
DeAntoni EP, Göktaş S, Stenner J, O’Donnell C, Crawford ED. A cross-sectional study of vasectomy, time since vasectomy and prostate cancer. Prostate Cancer Prostatic Dis. 1997;1:73–78.
Pereira S, Martinez M, Martinez FE, Júnior WM. Repercussions of castration and vasectomy on the ductal system of the rat ventral prostate. Cell Biol Int. 2006;30:169–74.
Flickinger CJ, Bush LA, Williams MV, Naaby-Hansen S, Howards SS, Herr JC. Post-obstruction rat sperm autoantigens identified by two-dimensional gel electrophoresis and western blotting. J Reprod Immunol. 1999;43:35–53.
Mo ZN, Huang X, Zhang SC, Yang JR. Early and late long-term effects of vasectomy on serum testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone levels. J Urol. 1995;154:2065–9.
Lee HK, Kim YG, Kim JS, Park EJ, Kim B, Park KH, et al. Cytokine-induced killer cells interact with tumor lysate-pulsed dendritic cells via CCR5 signaling. Cancer Lett. 2016;378:142–9.
Rider JR, Wilson KM, Sinnott JA, Kelly RS, Mucci LA, Giovannucci EL. Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up. Eur Urol. 2016;70:974–82.
Papa NP, MacInnis RJ, English DR, Bolton D, Davis ID, Lawrentschuk N et al. Ejaculatory frequency and the risk of aggressive prostate cancer: findings from a case-control study. Urol Oncol. 2017;35:530.e7–530.e13.
Conflict of interest
The authors declare no competing interests.
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Xu, Y., Li, L., Yang, W. et al. Association between vasectomy and risk of prostate cancer: a meta-analysis. Prostate Cancer Prostatic Dis (2021). https://doi.org/10.1038/s41391-021-00368-7