Circumcision and the risk of prostate cancer

Abstract

BACKGROUND: Several lines of evidence support a role for infectious agents in the development of prostate cancer (PCa). In particular, sexually transmitted infections (STIs) have been implicated in PCa etiology, and studies have found that the risk of acquiring a STI can be reduced with circumcision. Therefore, circumcision may reduce PCa risk. METHODS: Participant data collected as part of 2 population‐based case‐control studies of PCa were analyzed. Self‐reported circumcision status, age at circumcision, and age at first sexual intercourse were recorded along with a history of STIs or prostatitis. Multivariate logistic regression was used to estimate the relative risk of PCa by circumcision status. RESULTS: Data from 1754 cases and 1645 controls were available. Circumcision before first sexual intercourse was associated with a 15% reduction in risk of PCa compared to that of uncircumcised men (95% confidence interval [CI], 0.73‐0.99). This risk reduction was observed for cases with both less aggressive (odds ratio, 0.88; 95% CI, 0.74‐1.04) and more aggressive (odds ratio, 0.82; 95% CI, 0.66‐1.00) PCa features. CONCLUSIONS: Circumcision before first sexual intercourse is associated with a reduction in the relative risk of PCa in this study population. These findings are consistent with research supporting the infectious/inflammation pathway in prostate carcinogenesis. Cancer 2012. © 2012 American Cancer Society.

Abridged version: CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

“…In the Ugandan RCT on HIV negative men, MC did not reduce the risk of HSV-2 acquisition in women partners 63 . 69 . Another population-based study from Montreal also demonstrated no significant overall protective effect of MC (or infant MC), but the results where significant for men circumcised at ≥36 years of age (OR 0.55, 95% CI 0.30, 0.98) 70 .…”

CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants

“…A recent case control study explored the association between circumcision and prostate cancer [142]. In a multivariable analysis, controlling for age, family history, race, history of STI's, number of partners and history of prostatitis, the authors did not find an overall association with circumcision (OR 0.87, 95% CI 0.74-1.02).…”

Circumcision unlikely to be associated with prostate cancer risk

“…4 In this case, this would have led to an underrepresentation of uncircumcised (low SES) men among the controls, which could potentially account for the weak protective association with circumcision that Wright et al report. 1 Differential response rates (78% for cases and 67% for controls) enhance the plausibility of selection bias as an explanation for the observed association.…”

“…Second, strong selection biases related to socioeconomic status (SES) operating in case-control studies may have caused an artefactual association between circumcision and a reduced risk of prostate cancer in the study by Wright et al 1 In the United States, circumcision rates are substantially lower in men of lower SES; a populationbased study found that circumcision rates increased from 60% in men with less than a high school education to 84% in men with more than a high school education. 3 Response rates have also been found to be universally lower in controls of low SES in population-based studies.…”