Saturday, May 31, 2014

PHILADELPHIA: Prostate protection claim refuted by four experts [edited June 5]

Circumcision again shown to have no benefit, despite researchers' best efforts to spin the data

May 29, 2014

Lower risk of prostate cancer seen in circumcised blacks

[Yes and green jelly beans cause acne.]
by Randy Dotinga
THURSDAY, May 29, 2014 (HealthDay News) -- A new study on prostate cancer suggests that circumcision might have a preventive effect in black men and men who undergo the procedure later in life.

The findings are preliminary, and they don't suggest circumcision lowers the risk of prostate cancer for most men. Nor are experts recommending the procedure as a cancer-preventive strategy.

Still, "it may be that circumcision should be considered as an option for men at higher risk, such as black men and men with a family history of prostate cancer, but we need more research to confirm this," said study co-author Marie-Elise Parent. She is an associate professor of epidemiology at the University of Quebec's INRS-Institut Armand-Frappier Research Center in Laval, Canada.

Prostate cancer is the second-leading cause of cancer death in U.S. men, behind only lung cancer, according to the American Cancer Society. About one in seven men will be diagnosed with the disease in his lifetime [and one in three have been found to have it on autopsy], and prostate cancer will kill one in 36, the cancer society estimates.

"We still know very little about the potential causes of prostate cancer. There are probably many factors associated with it, but so far we have not been able to pin down what factors could be modified in order to prevent this cancer," Parent said. [Um, smoking?]

"All that we know for sure is that risk of developing it increases with age, that having a father, brother or son with prostate cancer increases one's risk, and that this cancer is more frequent among men of African ancestry," Parent added.

There's no way to use these risk factors to prevent the disease, she said.

Previous research has suggested that circumcision could slightly reduce the risk of prostate cancer, Parent said. Circumcision has also been linked to lower rates of sexually transmitted diseases like HIV, the virus that causes AIDS. However, circumcision remains controversial, with critics calling it barbaric, unnecessary and an impediment to sexual pleasure.

In the new study, published May 29 in the journal BJU International, researchers examined the medical records of 1,555 men treated for prostate cancer at a Montreal hospital from 2005-09. They compared them to 1,586 similar men who didn't have prostate cancer.

The researchers couldn't find a statistically significant difference in prostate cancer rates between circumcised and uncircumcised men.

However, the researchers did find a 60 percent lower risk of prostate cancer among circumcised black men. They also found evidence linking circumcision after age 35 to a 45 percent lower risk of prostate cancer.

But the findings merely point to an association between circumcision and lower risk in these two groups, not a direct cause-and-effect relationship.

The researchers reached their conclusions after adjusting their statistics for traits such as age at diagnosis and family history of prostate cancer. Due to the design of the study, researchers cannot offer simple numbers to describe the levels of risk for various types of men.

Parent cautioned that the black men in the study, mainly of French descent, may not reflect black men as a whole. And she said the study included few men who were circumcised at a later age, so that finding is potentially questionable.

Dr. Stephen Freedland, a urologist and associate professor of surgery and pathology at the Duke University School of Medicine in Durham, N.C., pointed out that men circumcised after age 35 are unusual. "They're usually older guys who are sick and have medical problems," he said.

The study findings as a whole aren't convincing, Freedland added, especially since it included relatively few black men -- just 178 of more than 3,100 participants.

"I don't think we'll be recommending massive circumcisions to prevent prostate cancer," he said. [He may not, but Brian Morris and others, predictibly, have.] "And men shouldn't go around thinking, 'I'm circumcised, therefore I'm safe from prostate cancer.'"

If circumcision does have a protective effect against prostate cancer -- and that's not proven -- why would that be so?

Circumcision at an early age may possibly protect against later sexually transmitted infections, which are thought to increase the risk of prostate cancer, Parent said. [But studies such as the Dickson cohort study found no such protection.]

"We tried to take this into consideration into our study," she said. "It did not seem to be the main explanatory factor, but it cannot be ruled out entirely, either."

New York Daily News
June 2, 2014

Chemo, circumcision could affect prostate cancer rates

by Meredith Engel
"We've known for a long time that circumcision has definite health benefits," Dr. Baskies continued. "Circumcision decreases the chances of HPV infection, the development of cancer of the penis, and now it appears it decreases the risk of the development of prostate cancer." ["But wait! There's more!..."]

But not all doctors are convinced of this study's merit.

"Even with the study, the official medical stance is still that there's no medical evidence to suggest that routine circumcision is a medically prudent intervention," said Dr. James McKiernan, interim chair of urology at NewYork-Presbyerian/Columbia University Medical Center.

Dr. McKiernan noted that the study's results are not significant enough to warrant change, and that the study subjects are "an unusual subgroup of people."

"I don't think the quality of the data is there to change practice," he said.
Previous research has found that circumcision also ...

Sense About Science
April 8, 2014

"Circumcision cuts risk of prostate cancer by 45%"

... Dr Matthew Hobbs, Deputy Director of Research at Prostate Cancer UK responded to the study saying:

“Although this study appears to show that circumcision after the age of 35 could reduce your risk of prostate cancer, the evidence presented is nowhere near strong enough that men should begin to consider circumcision as a way to prevent the disease. While the total sample studied was large, the number of men who had been circumcised after the age of 35 was very small, so this should not be seen as strong evidence of an association. There was no statistically significant association between prostate cancer and circumcision for men circumcised at all other ages. No reason was collected for circumcision, so we can’t say if the association is with circumcision later in life or with whatever causes men to have circumcisions after that age. It is also highly likely that diet, lifestyle, socioeconomic status and healthcare behaviours may have played a role in skewing these results.”
June 3, 2014

Circumcision Linked To Lowered Prostate Cancer Risk

by Krystnell Storr, Reuters
... Dr. Christopher Cooper, a professor and urologist at the University of Iowa told Reuters Health that the Canadian study does not justify promoting circumcision as prostate cancer prevention
The number of black men studied was too small for any conclusions to be drawn, he notes. Only 103 of the participants with prostate cancer were black men, and only 75 of the healthy men in the comparison group were black.

"The STD mechanism is possible but quite a stretch," Cooper said. He also pointed out that there were certain factors the researchers could not control in the study, such as how honest participants were about having STDs or, among the men circumcised as adults, the reason for their circumcision.
Parent told Reuters Health that even though the study was small, and she and her colleagues saw only a slightly reduced risk later in life among men who were circumcised as babies, the work is one more thing to consider when studying prostate cancer.

"We are too early in the game to make it a public recommendation. It could be that in the future it will be confirmed that it's a good thing and may have an added protection from other diseases," she added. [She virtually admits that this is advocacy research.]

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