Vasectomy and prostate cancer characteristics of patients referred for prostate biopsy

Purpose: The prospect of an association between vasectomy and prostate cancer has gained widespread attention and has potentially influenced patterns of referral. In patients referred for prostate needle biopsies we compared the incidence and characteristics of prostate cancer in those reporting a history of vasectomy to those denying prior vasectomy. Materials and Methods: A total of 585 consecutive prostate biopsy procedures were performed on 522 veterans during a 42-month period. Upon questioning 101 patients (19.3%) reported prior vasectomy. From the remaining 421 patients 202 consecutive age matched controls were selected. Pre-procedure prostate specific antigen levels, digital examination findings, incidence of prostate cancer, cancer grade and tumor length on biopsy cores were compared between the patients with and without a history of vasectomy. Results: Of the 101 patients who reported a history of vasectomy 46 (45.5%) had prostate cancer compared to 98 (48.5%) of the 202 age matched controls, and this difference was not statistically significant. Of the patients with prostate cancer those with prior vasectomy less frequently had an abnormal digital examination and lower prostate specific antigen levels, lower Gleason grade, lower clinical stage and shorter length of cancer on biopsies. Conclusions: We found no increase in prostate cancer incidence or severity in patients referred for prostate biopsy who had undergone prior vasectomy. In fact, prostate cancer was less common with fewer poor prognostic indicators in patients with previous vasectomy. These findings may be secondary to either selection bias, as patients with a vasectomy may seek more routine medical care, or a greater tendency of primary providers to refer these patients for evaluation.