Prostate cancer accounts for one-quarter of all new cancers in males and 7% of deaths in Australia [39] and 13% in the UK [96]. Risk of prostate cancer correlates with a history of sexually transmitted infections (STIs) [129, 142, 175, 410, 453, 475, 565], most consistently syphilis, gonorrhoea, chlamydia and HPV. HPV causes cervical cancer, but no consistent association has, however, been seen between rate of prostate cancer and rate of cervical cancer in different geographic localities [474].
Nevertheless, a study of 20,243 men in Finland found infection with HPV18 was associated with a 2.6-fold increase in risk of prostate cancer (P < 0.005) [148]. For HPV16 the increased risk was 2.4-fold. This is similar to the increased penile HPV infection in uncircumcised men [101].
In contrast, a Swedish study found an association of HPV33, but not HPV 16 or 18, with prostate cancer [2]. The recently discovered molony murine leukemia virus homologue XMRV (gene: HPC1) has been implicated in prostate cancer in patients homozygous for a genetic variant of HPC1 that encodes RNase L, an important component of antiviral defence mechanisms [583].
Such infections may establish in the prostate a state chronic active inflammation, which is associated with a variety of cancers [129]. The rate of STIs has risen over the past decade in many developed countries (eg, in the UK there are approx. 700,000 cases per year, one-third being in London [75]).
Uncircumcised men have a 1.6 to 2.0 fold higher incidence of prostate cancer compared with circumcised men [32, 170, 458], and prostate cancer is rare amongst Jews [14]. In Southern California the reduction in risk in circumcised men was 0.5 in whites and 0.6 in blacks [475].
Similarly, in Sweden uncircumcised males had twice the risk [32]. Of men operated on for prostatic obstruction, 1.8% of obstructions were cancerous in Jews (circumcised), compared with 19% of non-Jews [458]. A study in the UK in 1996 found an odds ratio for the reduction in risk in circumcised men was 0.62 [170]. Circumcision rate shows an inverse correlation with prostate cancer incidence in 51 countries (P = 0.022), supporting it having a protective effect against this disease (Jake Waskett, Manchester, personal communication).
Ascending passage of a particular STI to the prostate could be a causative factor in prostate cancer.
In the USA 1 in 6 men get prostate cancer during their lifetime [19]. Annual cases in 2006 were 0.25 million [327]. Average age of diagnosis is 70 years [261] and circumcision rate for these men (born in 1933–1947) is approx. 60% [327]. Across the range of a 1.6-2.0 fold increase in risk, calculations show that for these 40% of uncircumcised US men at the average age of prostate cancer diagnosis, there are 24–40% (45–67,000) more prostate cancer cases due to lack of circumcision [376].
The average cost for radiation therapy is US$13,823 [218] and the combined cost for terminal care for each of the 41,000 who die of prostate cancer each year is $24,660 per patient [587]. Thus lack of circumcision adds $0.8–1.6 billion to costs for treatment and terminal care each year in the USA [376]. In comparison, the total for (high-end) physician + hospital costs for neonatal circumcision in the USA of $195 represents merely $390 million per year [587]. And prostate cancer is just one of the conditions that circumcision provides protection against.
