Vasectomy and Risk of Aggressive Prostate Cancer: A 24-Year Follow-Up Study
Vasectomy and Risk of Aggressive Prostate Cancer: A 24-Year Follow-Up Study
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DOI：
10.1200/jco.2013.54.8446
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发表时间：
2014-09-20
影响因子：
45.3
通讯作者：
Mucci, Lorelei A.
中科院分区：
文献类型：
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作者：
Siddiqui, Mohummad Minhaj;Wilson, Kathryn M.;Mucci, Lorelei A.
关于输精管结扎术（美国男性避孕的一种常见形式）与前列腺癌风险之间的相关性，仍有目的明确的报道。我们前瞻性地研究了这种关联与长期随访和强调先进的和致命的diseases.Patients和MethodsAmong 49,405美国男性在卫生专业人员随访研究，年龄40至75岁的基线在1986年，6,023例前列腺癌患者被诊断为在后续到2010年，其中包括811例致命病例。总共有12，321名男性（25%）接受了输精管切除术。我们使用考克斯比例风险模型来估计总的，先进的，高级别的，和致命的疾病的相对风险（RR）和95%CI，调整各种可能的混杂因素。Results输精管结扎术与前列腺癌的风险增加一个小的整体（RR，1.10; 95%CI，1.04至1.17）。高级别（Gleason评分8 - 10; RR，1.22; 95%CI，1.03 - 1.45）和致死性疾病（死亡或远处转移; RR，1.19; 95%CI，1.00 - 1.43）的风险升高。在接受定期前列腺特异性抗原筛查的男性亚组中，与致死性癌症的相关性更强（RR，1.56; 95%CI，1.03至2.36）。输精管切除术与低度或局部疾病的风险无关。额外的分析表明，协会没有驱动的差异，性激素水平，性传播感染，或cancer treatment.ConclusionOur数据支持的假设，输精管结扎术与致命的前列腺癌的发病率适度增加。结果似乎不是由于检测偏倚，感染或癌症治疗不太可能造成混淆。(C)2014年美国临床肿瘤学会
PurposeConflicting reports remain regarding the association between vasectomy, a common form of male contraception in the United States, and prostate cancer risk. We examined prospectively this association with extended follow-up and an emphasis on advanced and lethal disease.Patients and MethodsAmong 49,405 US men in the Health Professionals Follow-Up Study, age 40 to 75 years at baseline in 1986, 6,023 patients with prostate cancer were diagnosed during the follow-up to 2010, including 811 lethal cases. In total, 12,321 men (25%) had vasectomies. We used Cox proportional hazards models to estimate the relative risk (RR) and 95% CIs of total, advanced, high-grade, and lethal disease, with adjustment for a variety of possible confounders.ResultsVasectomy was associated with a small increased risk of prostate cancer overall (RR, 1.10; 95% CI, 1.04 to 1.17). Risk was elevated for high-grade (Gleason score 8 to 10; RR, 1.22; 95% CI, 1.03 to 1.45) and lethal disease (death or distant metastasis; RR, 1.19; 95% CI, 1.00 to 1.43). Among a subcohort of men receiving regular prostate-specific antigen screening, the association with lethal cancer was stronger (RR, 1.56; 95% CI, 1.03 to 2.36). Vasectomy was not associated with the risk of low-grade or localized disease. Additional analyses suggested that the associations were not driven by differences in sex hormone levels, sexually transmitted infections, or cancer treatment.ConclusionOur data support the hypothesis that vasectomy is associated with a modest increased incidence of lethal prostate cancer. The results do not appear to be due to detection bias, and confounding by infections or cancer treatment is unlikely. (C) 2014 by American Society of Clinical Oncology