Chapter 14

THE QUESTION OF PROSTATE CANCER

A tight, unretractable foreskin, associated with extremely poor hygiene, can in rare instances be an implicating factor in cancer of the penis. Does the presence of the foreskin have any similar effect on the prostate gland? This gland is located at the base of the penis and surrounds the neck of the bladder. Although it is nowhere near the foreskin, lack of circumcision has been suggested to be a factor in the development of prostate cancer.

While cancer of the penis is extremely rare, prostatic cancer is relatively common. It has been cited as the third leading cause of American male cancer deaths. 1

In 1942 Ravich observed 840 cases of obstruction of the prostate, and found that among 768 Jewish patients, only 1.7% had prostate cancer, while among 75 non Jewish patients, 20% had cancer of the prostate. From this Ravich concluded that circumcision among the Jews was responsible for their low rate of this disease. 2

In 1965 Apt observed that prostate cancer was the most common form of cancer among males in Sweden. Virtually none of the males in Sweden are circumcised. Apt noted that:

“…The occurrence of prostatitis (which can develop into prostatic car­cinoma) … seems to be favoured by phimosis and balanitis.” 3

He compared the statistics for mortality of Sweden and Israel, and for Scandinavian Jews, and found that the cancer mortality for all types of cancer was roughly the same among Jews and non‑Jews but the prostatic cancer mortality was considerably lower among Jews. 3

Apt observed:

“The annual rate [of prostatic cancer] in Sweden is 414 [cases] per million males, in Israel 88. This suggests a very great difference between the two countries. But as prostatic cancer occurs typically within certain age groups, one must look at the relative age distribution…. Prostatic cancer is thus 4.7 times more frequent in Sweden than in Israel, but in the ages in which it is most common only 2.3 times.” 3

From this he inferred that universal circumcision in countries such as Sweden would greatly reduce that country’s future rate of prostate cancer.

Other authorities have challenged and discounted such claims:

Preston interpreted Apt’s statistics differently and challenged his findings. There are seven times as many men over age 60 in Sweden than in Israel. Since prostate cancer rarely occurs in men younger than 60, one would expect that Sweden would have a rate of prostate cancer at least seven times greater than that of Israel. However prostatic cancer is only 4.7 more frequent in Sweden than in Israel. “Would this mean that non‑circumcision protects against prostatic cancer?” 4

Wallerstein challenges Apt’s study by pointing out that he chose a country with an unusually high rate of prostatic cancer for his study:

“He selected Sweden -‑ a country with one of the highest rates of prostatic cancer -‑ as a basis for comparison with Israel, which was bound to bias the results. Had another noncircumcising country with a very low rate been chosen, completely opposite results would have been obtained.” 5

Wallerstein cites the statistics of the American Cancer Society in which the United States (with a high percentage of circumcised males), and Israel (with virtually all males circumcised), fall in the middle when the death rates per 100,000 population of various countries in 1972‑1973 are listed. The Netherlands, Sweden, and Switzerland rank highest with rates of 22.9, 21.1, and 19.3 respectively. The males in these countries are intact. The United States has a rate of 14.4. Israel’s rate is 7.5. However, El Salvador, Honduras, and Thailand, all countries which do not practice circumcision, report extremely low rates of 1.2, 0.8, and 0.2 respectively. 6

Age is not accounted for in these figures. It may be that the countries with lower rates of prostatic cancer have fewer elderly men. However, it is still significant to note that the United States and Israel do not have unusually low rates of prostatic cancer despite their adoption of circumcision.

Heredity may be a factor in the lower rates of prostatic cancer among Jews compared to some other peoples.

Kaplan and O’Conor observed 886 patients with prostate hyperplasia (excessive growth of normal tissues). 184 of these showed carcinoma. 182 were Jewish, 16 of whom had carcinoma. 23.9% of the non‑Jewish patients and 8.8% of the Jewish patients had carcinoma. However, 40.2% of the Gentile patients were circumcised, and 35.9% of the Gentiles with prostatic carcinoma were circumcised.

They state:

“There seems to be a general agreement in the literature that the incidence of carcinoma of the prostate is lower in Jews than in Gentiles.” 7

This appears to be independent of lack of foreskin, for according to their statistics, among the non‑Jewish patients there is no appreciable difference in the percentage of circumcised males who did and did not develop prostatic carcinoma.

Kaplan and O’Conor add:

“Ravich postulated that a carcinogen present in smegma migrates up the urethra and is a factor in the development of carcinoma of the prostate. Since carcinoma usually arises in the posterior lobe of the prostate, this hypothesis seems untenable…. More likely [there is a] genetic predilection for the development of carcinoma of the prostate among Gentiles as compared to Jews….

“Despite other arguments mustered for or against the practice of circumcision, the relation of this operation to the subsequent development of prostatic carcinoma does not seem evident. If one supports circumcision as a routine procedure, the prevention of prostatic cancer should not be used as a reason to countenance such action.” 7

Wallerstein points out that regional differences of the rates of prostatic cancer vary widely throughout different parts of the United States, Canada, and other parts of the world, irrespective of circumcision status. 8

He also adds that according to the American Cancer Society, the incidence of prostatic cancer has increased in the United States “by more than 20% in the past 25 years” despite our country’s increasing circumcision rate. 9

The cause of prostatic cancer is not known. Many factors have been implicated. Sexually Transmitted diseases may be a significant factor. According to Stagg:

“One investigator found that 67 percent of his patients with cancer of the prostate had a prior history of venereal disease.” 10

The Ad Hoc Task Force of the American Academy of Pediatrics has concluded:

“There is presently no convincing scientific evidence to substantiate the assertion that circumcision reduces the eventual incidence of cancer of the prostate.” 11

It appears that the lower incidence of prostate cancer among Jewish males is related to heredity, lifestyle, personal health and cleanliness. The presence or absence of the foreskin appears to have nothing to do with the development of this disease.

References:

  1. Wallerstein, Edward Circumcision; An American Health Fallacy Springer Publishing Company, New York, c. 1980, p. 100.  (His reference: American Cancer Society, 1978, Cancer Facts, p. 10.)
  2. Ravich, A.  “The Relationship of Circumcision to Cancer of the Prostate”  Journal of Urology, Vol. 48, 1942, p. 298‑299.
  3. Apt, Adolf  “Circumcision and Prostatic Cancer” Acta Medica Scandinavica, Vol. 178, April 1965, p. 493‑504.
  4. Preston, Capt. E. Noel, MC, USAF  “Whither the Foreskin? A Consideration of Routine Neonatal Circumcision” Journal of the American Medical Association, Sept. 14, 1970, Vol. 213, No. 11, p. 18531858.
  5. Wallerstein, p. 101
  6. Ibid., p. 100.  (His reference: American Cancer Society, 1978 Cancer Facts and Figures [New York, 1977], p. 15.)
  7. Kaplan, George W., M.D. & O’Conor, Vincent J., Jr., M.D. “The Incidence of Carcinoma of the Prostate in Jews and Gentiles”  J.A.M.A., Vol. 196, No. 9, May 30,1966, p. 803.
  8. Wallerstein, p. 102. (His reference: L.M. Franks “Etiology, Epidemiology and Pathology of Prostatic Cancer,” Proceedings of the National Conference on Urologic Cancer [New York: American Cancer Society, 1973], p. 1092-1095.)
  9. Ibid., p. 102.  (His reference: American Cancer Society, 1978 Cancer Facts, p.7.)
  10. Stagg, Del, Ph.D.  “A Basis for Decision on Circumcision” From Compulsory Hospitalization or Freedom of Choice in Childbirth?, Vol. III, (Transcripts of the 1978 NAPSAC Convention ‑ Stewart & Stewart) Ch.63,p.833.
  11. Thompson, Hugh C., M.D.; King, Lowell R., M.D.; Knox, Eric, M.D.; & Korones, Sheldon B., M.D. “Ad Hoc Task Force on Circumcision ‑ Report” Pediatrics, Vol. 56, No. 4, October 1975, p. 610‑611.