History of Vasectomy Is Not Associated with Prostate Cancer Progression in Men on Active Surveillance

The relationship between vasectomy and prostate cancer risk has been debated for decades without much resolution. Although many studies have tried to answer whether a prior vasectomy increases the risk of a subsequent prostate cancer diagnosis, no study to date has investigated whether a history of vasectomy might influence disease progression among men already diagnosed with prostate cancer. In our study, we examined a large cohort of men on active surveillance to determine whether prior vasectomy was associated with an increased risk of Gleason score upgrading, a clinically meaningful endpoint.

Using data from our institutional Active Surveillance Program, which has enrolled men with favorable-risk prostate cancer since 1995, we found no significant association between a history of vasectomy and risk of disease upgrading, also termed grade reclassification. This was consistent even after adjusting for known clinical predictors of grade progression, such as PSA density and number of cores positive for cancer on biopsy. We also evaluated whether the time from vasectomy to prostate cancer diagnosis influenced risk of progression and found no meaningful association.

Our findings offer reassurance to patients and clinicians: a history of vasectomy does not appear to portend more aggressive disease in men undergoing active surveillance. This study is valuable for patients weighing treatment options or continuing on active surveillance who may worry that past decisions could impact their future. After all, data is not just about clarity. They can bring peace of mind.

Written by:

Aurora J. Grutman, MPH, Johns Hopkins Bloomberg School of Public Health and Johns Hopkins School of Medicine, Baltimore, Maryland, USA
Christian P. Pavlovich, MD, Johns Hopkins School of Medicine, James Buchanan Brady Urological Institute, Baltimore, Maryland, USA

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