Ejaculation Frequency and Risk of Prostate Cancer: Updated Results with an Additional Decade of Follow-up

Abstract

Background Evidence suggests that ejaculation frequency may be inversely related to the risk of prostate cancer (PCa), a disease for which few modifiable risk factors have been identified. Objective To incorporate an additional 10 yr of follow-up into an original analysis and to comprehensively evaluate the association between ejaculation frequency and PCa, accounting for screening, clinically relevant disease subgroups, and the impact of mortality from other causes. Design, setting, and participants A prospective cohort study of participants in the Health Professionals Follow-up Study utilizing self-reported data on average monthly ejaculation frequency. The study includes 31 925 men who answered questions on ejaculation frequency on a 1992 questionnaire and followed through to 2010. The average monthly ejaculation frequency was assessed at three time points: age 20–29 yr, age 40–49 yr, and the year before questionnaire distribution. Outcome measurements and statistical analysis Incidence of total PCa and clinically relevant disease subgroups. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results and limitations During 480 831 person-years, 3839 men were diagnosed with PCa. Ejaculation frequency at age 40–49 yr was positively associated with age-standardized body mass index, physical activity, divorce, history of sexually transmitted infections, and consumption of total calories and alcohol. Prostate-specific antigen (PSA) test utilization by 2008, number of PSA tests, and frequency of prostate biopsy were similar across frequency categories. In multivariable analyses, the hazard ratio for PCa incidence for ≥21 compared to 4–7 ejaculations per month was 0.81 (95% confidence interval [CI] 0.72–0.92; p < 0.0001 for trend) for frequency at age 20–29 yr and 0.78 (95% CI 0.69–0.89; p < 0.0001 for trend) for frequency at age 40–49 yr. Associations were driven by low-risk disease, were similar when restricted to a PSA-screened cohort, and were unlikely to be explained by competing causes of death. Conclusions These findings provide additional evidence of a beneficial role of more frequent ejaculation throughout adult life in the etiology of PCa, particularly for low-risk disease. Patient summary We evaluated whether ejaculation frequency throughout adulthood is related to prostate cancer risk in a large US-based study. We found that men reporting higher compared to lower ejaculatory frequency in adulthood were less likely to be subsequently diagnosed with prostate cancer.

Ejaculation Frequency and Risk of Prostate Cancer A Systematic Review

“…Finally, this systematic review only included 2 studies. 12,13 The studies screened of this process was shown in Figure 1. Characteristics of patient were summarized in Table 1.…”

“…PCa was less frequently diagnosed among men who had the higher ejaculation frequency (21 or more ejaculations per month, multivariable HR, 95% CI, 0.81, (0.72, 0.92), P<0.0001 for trend, ages 20 to 29 years; multivariable HR, 95% CI, 0.78, (0.69, 0.89), P<0.0001 for trend, ages 40 to 49 years] compared with men reporting 4 to 7 ejaculations per month. 13 The two trials 12,13 indicated that higher ejaculation frequency is associated with reducing risk of PCa. However, lower ejaculation frequency is not associated with reducing risk of PCa.…”

“…Characteristics of patient were summarized in Table 1. Quality assessment of included studies were summarized in 12 Rider et al, 13 showed that there were 3839 men diagnosed with PCa during 480831 person-years. PCa was less frequently diagnosed among men who had the higher ejaculation frequency (21 or more ejaculations per month, multivariable HR, 95% CI, 0.81, (0.72, 0.92), P<0.0001 for trend, ages 20 to 29 years; multivariable HR, 95% CI, 0.78, (0.69, 0.89), P<0.0001 for trend, ages 40 to 49 years] compared with men reporting 4 to 7 ejaculations per month.…”

“…This systematic review have several limitations. Firstly, the included studies 12,13 have poor methodological quality, which degrades reliability of systematic review. In addition, this systematic review only included two studies, and it may be lack of stable statistical significance in such a small number of studies ( Figure 1).…”

Erectile Dysfunction: A Review of Comprehensive Treatment Options for Optimal Outcome

“…PDE5i use may lower prostate cancer risk, possibly because men who use them may ejaculate more frequently, which protects against prostate cancer. 128,129 Long-term sildenafil citrate (Viagra) use is associated with a slightly increased risk for melanoma. 130 Most common side effects of PDE5i include headache in up to 20% of men, flushing in up to 15%, and dyspepsia and nasal congestion in up to 10%.…”