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Prostate cancer accounts for one-quarter of all new cancers in males and 7% of deaths [21]. Uncircumcised men have more than twice the incidence of prostate cancer compared with circumcised [16, 103, 287], and prostate cancer is rare amongst Jews [9]. No association has been seen between rate of prostate cancer and rate of cervical cancer in different geographic localities [297]. However, in a study of 20,243 men in Finland , infection with HPV18 was associated with a 2.6-fold increase in risk of prostate cancer (P < 0.005) [88]. For HPV16 the increased risk was 2.4-fold. This is similar to the increased penile HPV infection in uncircumcised men [60]. Ascending passage of the HPV to the prostate could be causative.
According to the American Cancer Society 1 in 6 men get prostate cancer during their lifetime. If uncircumcised men have double the risk, and assuming half of the men in the at-risk age group are uncircumcised, then risk in an uncircumcised man would be 1 in 4, and risk in a circumcised man would be 1 in 8 (i.e., circumcision prevents prostate cancer in 33% minus 11% = 22% of men). This means that in the USA the 2 million circumcisions performed each year prevent approx. 22% of 2M = 440,000 cases of prostate cancer over the average 76 year lifetime. Each case costs on average US$13,823 just for radiation therapy [136], meaning a total extra cost of US$6 billion. Add to this the combined cost for terminal care of the 41,000 who die of prostate cancer each year of $24,660 per patient [136] (= $1 billion), the overall annual cost is over US$7 billion. This compares with US$390 million per year in total for a high-end estimate of physician + hospital costs for a neonatal circumcision in the USA of $195 [365]. [These calculations were assisted by Jake Waskett, Joshua Amos and Tatsuo Bradio (unpublished).]
