Male circumcision and prostate cancer: A geographical analysis, meta-analysis, and cost analysis

Abstract

Introduction: Attempts to find an association between male circumcision and prostate cancer risk have produced inconsistent results. Methods: Age-standardized prostate cancer incidence, life-expectancy, geographical region, and circumcision prevalence from 188 countries were compared using linear regression analysis. Following a systematic literature review, a meta-analysis was performed on studies meeting inclusion criteria with evaluations of between-study heterogeneity and publication bias. A cost analysis (discounted at 3% and 5% per annum) was performed using the meta-analysis’s summary effect and upper confidence interval (CI). Results: Univariate analysis revealed a trend for a positive association between country-level age-standardized prostate cancer incidence (per 100 000 person-years) and circumcision prevalence (β=0.0887; 95% CI -0.0560, +0.233) while multivariate analysis found a significant positive association (β=0.215; 95% CI 0.114, 0.316). Twelve studies were included in meta-analysis. The random-effects summary odds ratio was 1.09 (95% CI 0.95, 1.23; between-study heterogeneity