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PICOT Statement

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Nursing Practice Problem

Various concerns have been raised by male patients concerning the possibility that undergoing vasectomy predisposes one to an increased risk of getting prostate cancer. Cases have also been documented detailing how some patients would change their mind after being advised by their families and friends against pursuing vasectomy in the belief that the procedure will increase their chances of getting cancer (Kiciński, Vangronsveld & Nawrot, 2011).

PICOT Question

Do male patients who undergo vasectomy have an increased risk of getting prostate cancer as compared to those who do not?

Quantitative Studies

Study One

Siddiqui, M. M., Wilson, K. M., Epstein, M. M., Rider, J. R., Martin, N. E., Stampfer, M. J., & Mucci, L. A. (2014). Vasectomy and risk of aggressive prostate cancer: a 24-year follow-up study. Journal of Clinical Oncology, 32(27), 3033-3038.

Abstract

Purpose

Conflicting 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 Methods

Among 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.

Results

Vasectomy 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.

Conclusion

Our 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 unlikel

Study Two

Tyagi, B., Manoharan, N., & Raina, V. (2010). A case control study on prostate cancer in Delhi. The Asian Pacific Journal of Cancer Prevention, 11(2), 397-401.

Abstract

Prostate cancer is one of the first five leading site of cancers in Delhi. The incidence rate is higher in North India compared to South India and it is rapidly increasing. A population based case-control study on prostate cases was therefore carried out in Delhi to identify potential risk factors. Cases were each matched with two controls. Past smoking and current alcohol consumption significantly increased the risk of prostate cancer. No statistically significant association was found with family history of cancer or prostate cancer. The risk of prostate
cancer declined with increasing dietary consumption of tea, citrus fruits and melon. A statistically significant marginal increase in the odds ratio was observed with the consumption of eggs, fish and sunflower oil. Though an increased risk of prostate cancer was evident among vasectomized men, the association was not statistically significant.

Study Three

Romero, F. R., Romero, A. W., Almeida, R. M. S. D., Oliveira Jr, F. C. D., & Tambara Filho, R. (2012). The significance of biological, environmental, and social risk factors for prostate cancer in a cohort study in Brazil. International Brazilian Journal of Urology, 38(6), 769-778.

Abstract

Purpose

To evaluate the significance of several risk factors for prostate cancer in a cohort of Brazilian men.

Subjects and methods:

Men ≥ 40 years-old participating in a prostate cancer screening program between December 2006 and April 2011 in the city of Curitiba, Brazil, were evaluated to determine the prevalence, relative risk (RR) and 95% CI of prostate cancer according to age, race, ethnicity, family history of prostate cancer, educational level, and history of vasectomy, increased blood pressure, diabetes mellitus, and urethritis.

Results

In 2121 men included in this study, prostate cancer prevalence was 0.6% for men between 40-49 years versus 2.0% (adjusted RR = 2.58), 7.7% (adjusted RR = 5.76), and 8.4% (adjusted RR = 4.88) for men 50-59 years, 60-69 years, and ≥ 70 years, respectively (p < 0.05 to all). The prevalence of cancer was 5.1% in blacks versus 3.3% in whites (adjusted RR = 1.56, p > 0.05); 6.1% in African descendants, in comparison to 3.0% in non-African descendants (adjusted RR = 3.17, p < 0.05); 5.1% in men with a positive family history, compared to 2.5% in those with no family history (adjusted RR = 1.55, p > 0.05); and 4.8% in participants with incomplete elementary school level or lower, compared to 2.2% in men with complete elementary school level or higher education (adjusted RR = 1.85, p > 0.05). Men with/without history of vasectomy, increased blood pressure, diabetes, and urethritis had a prostate cancer prevalence of 0.8%/3.0% (adjusted RR = 0.23, p > 0.05), 3.8%/2.2% (adjusted RR = 1.16, p > 0.05), 3.7%/2.6% (adjusted RR = 1.39, p > 0.05), and 2.6%/2.6% (adjusted RR = 0.99, p > 0.05), respectively.

Conclusions

Risk factors associated with an increased prevalence of prostate cancer in this cohort included increasing age and African ethnicity.

Qualitative Studies

Study One.

Garner, I. D. (2011). A Q-Methodological Study of Male Attitudes towards Testicular Cancer and Testicular Self-Examination. Inquiries Journal, 3(11).

Abstract

This study used Q-methodology in order to explore the diverse range of meanings and understandings that young males construct in relation to testicular cancer (TC) and testicular self-examination (TSE). Using both conventional and online methods of Q-sorting, twenty-seven males aged 18 to 43 sorted a number of statements along a continuum from ‘strongly disagree’ to ‘strongly agree’. Statements represented a wide range of viewpoints concerning the risk factors, causes and symptoms of TC, popular ideas and common myths about TC and TSE, and the emotional consequences of TC. Centroid factor analysis of the 27 completed Q-sorts revealed four distinct perspectives. The four factors are interpreted and discussed relative to the current research position concerning the negative influence of masculine values on men’s testicular screening behaviours. These four accounts were labelled: Media Influenced, Knowledgeable, Cautious and Mislead. The four perspectives contained different accounts concerning the causes and symptoms of TC, yet participants representing each perspective were unanimous in endorsing TSE. Results indicate that young males were more likely to have heard of TC and TSE in comparison to previous studies assessing knowledge of the disease and self-screening practices. Comment is made on the potential implications for public health awareness, and limitations to the study are acknowledged.

Study Two

Alqahtani, K. S., Srinivasan, S., Mital, D. P., & Haque, S. (2015). Analysis of risk factors for prostate cancer patients. International Journal of Medical Engineering and Informatics, 7(4), 365-380.

Abstract

This study tries to identify some of the key risk factors for those patients who are more likely to be diagnosed with prostate cancer. These risk factors include age, race/ethnicity, family history of prostate cancer, family history of any other type of cancer, obesity, smoking, alcohol abuse, cholesterol, vitamin D deficiency, inflammation of prostate, vasectomy, and hypertension. The study finds, age, race, positive family history of prostate cancer, a positive family history of any other type of cancer, hypercholesterolemia, vitamin D deficiency, inflammation of prostate, vasectomy, and hypertension are significantly associated with prostate cancer. However, obesity, alcohol abuse, and smoking show negative association with prostate cancer.

Study Three

Ross, L., Dark, T., Orom, H., Underwood, W., Anderson-Lewis, C., Johnson, J., & Erwin, D. O. (2011). Patterns of information behavior and prostate cancer knowledge among African–American men. Journal of Cancer Education, 26(4), 708-716.

Abstract

The purposes of this study are to explore cancer information acquisition patterns among African–American men and to evaluate relationships between information acquisition patterns and prostate cancer prevention and control knowledge. A random sample of 268 men participated in a statewide interviewer-administered, telephone survey. Men classified as non-seekers, non-medical source seekers, and medical source seekers of prostate cancer information differed on household income, level of education, and beliefs about personal risk for developing prostate cancer. Results from multiple regression analysis indicated that age, education, and information-seeking status were associated with overall levels of prostate cancer knowledge. Results from logistic regression analyses indicated that men who included physicians as one of many information resources (medical source seekers) had superior knowledge over non-seekers and non-medical source seekers on 33% of individual knowledge details. The findings emphasize the need to connect lower-income and lower-educated African–American men to physicians as a source of prostate cancer control information.

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