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Is Fatherhood a Risk Factor for Prostate Cancer?

February 2013, Vol 4, No 2

Socioeconomic status and other nonphysiologic factors may be largely responsible for the apparent association between having fathered a child and an increased risk for prostate cancer, Swedish researchers have concluded.

They analyzed data from the National Prostate Cancer Register of Sweden and found that, although childless men had a significantly lower risk of prostate cancer than fathers, this association was attenuated when they took into account marital status and educational level. The unadjusted odds ratio (OR) of developing cancer among childless men compared with fathers was 0.71 for cancers diagnosed by prostate-specific antigen (PSA) testing, and after adjustment it was 0.86. The ORs for cancers detected as a result of symptoms were 0.86 and 0.90, respectively.

“Our data indicate that the association between fatherhood status and prostate cancer is due to a large extent to socioeconomic factors influencing healthcare-seeking behavior, including testing of PSA levels, and that the remaining association may be due to confounding factors,” concluded lead investigator Pär Stattin, MD, PhD, Department of Urology, Umeå Uni­versity, Sweden, and colleagues in a new study (Wirén SM, et al. Int J Cancer. 2013 Jan 25 [Epub ahead of print]).

The investigators analyzed data from 117,328 men with prostate cancer and 562,644 without prostate cancer. They found an OR of 0.83 for prostate cancer among childless men compared with fathers in a univariate analysis. When the researchers then focused only on low-risk, localized tumors, they found the OR was even lower (0.74), whereas for metastatic cancer it was higher (0.93). After adjusting for marital status and educational level in a multivariate analysis, the team found that the overall OR for prostate cancer increased to 0.91 for childless men versus for fathers. The respective adjusted ORs for low-risk cancer and for metastatic disease were 0.87 and 0.92.

Married men had an unadjusted OR of 1.31 for prostate cancer, whereas divorced men had an unadjusted OR of 1.19.

Overall, men with more education had an unadjusted OR of 1.16 compared with men with less education. There was a stronger association for low-risk tumors but a slightly weaker association for metastatic prostate cancer.

In addition, an unadjusted analysis indicated men without children had an OR of 0.71 for cancer diagnosed by PSA testing and of 0.86 for cancer detected from symptoms. These associations were attenuated in the adjusted analysis.

The team also found, overall, that the lowest OR for developing prostate cancer was in childless men with a low educational level. In a separate analysis, they found the association between fatherhood status and the risk of prostate cancer was stronger for low-risk tumors among men with a low educational level than among those with a high educational level.

“These associations are likely due to a higher uptake of PSA testing among married men and men with high educational levels,” the researchers concluded. That is, the results reflect propensity to obtain a diagnosis.

The extent to which the small remaining reduction in risk for cancer among childless men after adjustment for marital status and education is a result of residual confounding factors “cannot be elucidated by use of our data.”

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